Apparatuses, systems, and methods for transporting medications from a central pharmacy to a patient in a healthcare facility

ABSTRACT

Provided herein are various apparatuses, systems, and methods for improving the efficiency of medication distribution within a healthcare facility. In particular, embodiments may provide for dispensing medications needed and medications anticipated to be needed to an authorized medical person for administration to a patient in a healthcare facility. Methods may include receiving an indication of one or more unit dose medications anticipated to be needed by a patient; retrieving the one or more unit dose medications from a unit storage device; loading the one or more unit dose medications onto a transport device; transporting the one or more unit dose medications from the unit storage device to a location proximate the patient; and transferring the one or more unit dose medications from the transport device to a staging area at the location proximate the patient.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims priority to U.S. patentapplication Ser. No. 16/677,157, filed on Nov. 7, 2019, which is acontinuation of and claims priority to U.S. patent application Ser. No.16/391,921, filed on Apr. 23, 2019, which is a continuation of andclaims priority to U.S. patent application Ser. No. 16/018,580, filed onJun. 26, 2018, which is a continuation of and claims priority to U.S.patent application Ser. No. 15/057,783, filed on Mar. 1, 2016, which isa continuation of and claims priority to U.S. patent application Ser.No. 13/836,107, filed on Mar. 15, 2013, which is a Non-Provisionalapplication claiming priority to U.S. Provisional Patent ApplicationSer. Nos. 61/713,228, 61,713,258, 61/713,268, 61/713,278, 61/713,298,61/713,307, 61/713,321, 61/713,395, 61/713,360, 61/713,370, and61/713,409, each filed on Oct. 12, 2012, and each of the aforementionedapplications are herein incorporated by reference in their entirety.

TECHNOLOGICAL FIELD

Embodiments of the present invention relate generally to medicationdispensing from the central pharmacy or medication storage area in ahealthcare facility to a patient. Embodiments may include full orpartial automation of the process and may include mechanisms forimproving the efficiency and accuracy of medication dispensing.

BACKGROUND

Medication dispensing in healthcare facilities can be a complex and timeconsuming process. With medication orders changing, and with thesignificant potential ramifications of dispensing the incorrectmedication to a patient, the process of delivering medication from thecentral pharmacy to the patient can be a high-risk process in ahealthcare setting.

Healthcare facilities generally dispense medications from a centralpharmacy to patients with a number of verification steps performed alongthe way to ensure that the medication is of the correct type and doseand that the appropriate patient receives the medication. Theverification steps may add complexity and time to the process, therebyreducing the efficiency. Therefore it may be desirable to implementapparatuses, systems, and methods which may automate some or all of theprocess and which may increase the efficiency with which medications aredelivered to a patient.

SUMMARY

Embodiments of the present invention may provide various apparatuses,systems, and methods for improving the efficiency of medicationdistribution within a healthcare facility. In particular, embodimentsmay provide for dispensing medications needed and medicationsanticipated to be needed to an authorized medical person foradministration to a patient in a healthcare facility. Medications thatare anticipated to be needed may be predicted based on a number offactors. The medications may be gathered, transported, stored, staged,and dispensed using one or more of the components described herein.Combinations of the components may be implemented for a system toautomate or partially automate the dispensing of medications from acentral pharmacy of a healthcare facility to a patient.

An example embodiment of the present invention may a method includingreceiving an indication of one or more unit dose medications anticipatedto be needed by a patient; retrieving the one or more unit dosemedications from a unit storage device; loading the one or more unitdose medications onto a transport device; transporting the one or moreunit dose medications from the unit storage device to a locationproximate the patient; and transferring the one or more unit dosemedications from the transport device to a staging area at the locationproximate the patient. Receiving an indication of one or more unit dosemedications anticipated to be needed by the patient may includepredicting the one or more unit dose medications anticipated to beneeded by a patient over a specified period of time based on at leastone of a conventional medication regimen for a particular ailment, aphysician specific medication regimen for a particular ailment, ahistorical record of unit dose medications, or an algorithm. Thealgorithm may be based upon one or more of patient gender, patient age,patient symptoms, or patient vital statistics including one or more oftemperature, pulse, blood-oxygen content, cholesterol level, or bloodsugar.

According to methods of example embodiments, receiving an indication ofone or more unit dose medications anticipated to be needed by a patientmay include receiving a request for the one or more unit dosemedications anticipated to be needed by the patient. Methods may alsoinclude estimating the time of arrival of the one or more unit dosemedications at the location proximate the patient, and providing theestimated time of arrival. Retrieving the one or more unit dosemedications from the unit storage device may include directing an X-Yrobot to a location within the unit storage device for reach of the oneor more unit dose medications, and retrieving each of the one or moreunit dose medications from their respective locations within the unitstorage device. Transporting the one or more unit dose medications fromthe unit storage device to the location proximate the patient mayinclude advancing the one or more unit dose medications along a trackwith a car carrying the one or more unit dose medications.

Methods of example embodiments may optionally include dispensing the oneor more unit dose medications from the staging area to authorizedmedical personnel in response to receiving a request from the authorizedmedical personnel. Receiving a request from authorized medical personnelmay include identifying the authorized medical personnel by at least oneof a biometric scan, receipt of an identification number, or receipt ofidentifying credentials. Methods may include retrieving at least one ofthe one or more unit dose medications from the staging area in responseto a recall of the at least one of the one or more unit dosemedications.

Example embodiments of the present invention may provide for a systemfor transporting medication within a healthcare environment. The systemmay include: a unit storage device configured to store a plurality ofunit dose medications; a retrieving device configured to retrieve one ormore of the plurality of unit dose medications from the unit storagedevice; a transport device configured to transport the retrieved one ormore of the plurality of unit dose medications to a location proximatethe patient; and a loading device configured to load the retrieved oneor more plurality of unit dose medications onto the transport device.Each of the plurality of unit dose medications may be stored within theunit storage device in a bin, wherein each bin may include a uniformprofile. Each of the plurality of unit dose medications may be storedwithin the unit storage device in an overpack, wherein each overpackincludes unique identifying indicia disposed thereon.

Systems according to example embodiments may optionally include ascanner attached to the retrieving device, where the scanner isconfigured to scan the identifying indicia of each overpack prior toretrieval. Each bin containing a unit dose medication may be disposed ina compartment, where the compartments are arranged along a substantiallyvertical plane, where each compartment is directly accessible by theretrieving device. The retrieving device may include an X-Y robotconfigured to move across the substantially vertical plane and retrievethe one or more of the plurality of unit dose medications. The transportdevice may include a car, where the car includes a payload area and oneor more bogies. The car may be configured to be driven along a track byan electric motor disposed within the transport device. The loadingdevice may be configured to advance the one or more of the plurality ofunit dose medications from the retrieving device to the payload area ofthe transport device. Systems may optionally include an unloadingdevice, where the unloading device is configured to unload one or moreof the plurality of unit dose medications from the transport device. Theunloading device may be configured to unload one or more of theplurality of unit dose medications to at least one of a proximatestorage location for retrieval by authorized medical personnel, or astaging area to await dispensing.

DESCRIPTION OF THE DRAWINGS

Reference now will be made to the accompanying drawings, which are notnecessarily drawn to scale, and wherein:

FIG. 1 illustrates an example embodiment of overpacks as describedherein using multiple sized bins of a common profile;

FIG. 2 illustrates another example embodiment of overpacks includinglidded containers of multiple sizes, each having a common profile;

FIG. 3 illustrates another example embodiment of an overpack including aflexible film pouch with a grasping loop;

FIG. 4 illustrates an example embodiment of bags used as an overpack;

FIG. 5 illustrates multiple sized boxes as overpacks;

FIG. 6 illustrates automated loading of overpacks according to anexample embodiment of the present invention;

FIG. 7 illustrates another example embodiment of an overpack including acard-stock backing;

FIG. 8 illustrates the storage of overpacks according to an exampleembodiment of the present invention;

FIG. 9 illustrates a magazine containing a plurality of stacked unitdose medications according to an example embodiment of the presentinvention;

FIG. 10 illustrates a plurality of interconnected unit dose medicationpackages;

FIG. 11 illustrates a system loading device including a plurality ofbins of multiple sizes and a common profile according to an exampleembodiment of the present invention;

FIG. 12 illustrates an example embodiment of a system configured to loadoverpacks and group loaded overpacks onto a tray or cassette;

FIG. 13 depicts loading a magazine with a loaded overpack according toan example embodiment of the present invention;

FIG. 14 illustrates another example embodiment of a system for selectingand loading overpacks;

FIG. 15 illustrates a system for loading overpacks using a carouselcontaining a plurality of unit dose magazines according to an exampleembodiment of the present invention;

FIG. 16 illustrates an example embodiment of an apparatus to organizeand transport medication and supplies according to the presentinvention;

FIG. 17 illustrates the example embodiment of FIG. 16 adapted to carryand transport larger items;

FIG. 18 illustrates an example embodiment of an apparatus configured totransport overpacks from a central pharmacy to a unit storage device;

FIG. 19 illustrates another example embodiment of an apparatusconfigured to transport overpacks from a central pharmacy to a unitstorage device;

FIG. 20 illustrates a unit storage device supplied by an apparatusconfigured to transport overpacks from a central pharmacy according toexample embodiments of the present invention;

FIG. 21 illustrates another unit storage device according to exampleembodiments of the present invention;

FIG. 22 illustrates an example embodiment of a high-capacity unitstorage device;

FIG. 23 illustrates another unit storage device including a retrievaldevice and a transport device according to an example embodiment of thepresent invention;

FIG. 24 illustrates a unit storage device including a loading deviceaccording to an example embodiment of the present invention;

FIG. 25 illustrates a method for loading and dispensing overpacks from ahigh-capacity unit storage device according to example embodiments ofthe present invention;

FIG. 26 illustrates a unit storage device according to another exampleembodiment of the present invention;

FIG. 27 illustrates a unit storage device according to yet anotherexample embodiment of the present invention;

FIG. 28 illustrates an example embodiment of a carrier configured tocarry overpacks and a shuttle configured to transport the carrier;

FIG. 29 illustrates a transport device and a loading device according toan example embodiment of the present invention;

FIG. 30 depicts a track-based transport system according to an exampleembodiment of the present invention;

FIG. 31 illustrates a cross-section of a track used with track-basedtransport systems of example embodiments of the present invention;

FIG. 32 illustrates a pair of end caps configured to join track sectionstogether according to example embodiments of the present invention;

FIG. 33 illustrates an example embodiment of a female end cap used tojoin to join track sections together according to an example embodimentof the present invention;

FIG. 34 illustrates an example embodiment of a male end cap used to jointrack sections together according to an example embodiment of thepresent invention;

FIGS. 35 and 36 illustrate a method of engagement of a male end cap anda female end cap in order to join track sections together according toexample embodiments;

FIG. 37 illustrates a cross-section of the end caps of FIGS. 35 and 36in an engaged position;

FIG. 38 depicts a female end cap including an alignment and securingfeature for aligning and securing together track sections according toexample embodiments of the present invention;

FIG. 39 illustrates an example embodiment of a car of a track-basedtransport system traversing a corner;

FIG. 40 illustrates an example embodiment of a car of a track-basedsystem traversing an incline;

FIG. 41 illustrates the engagement of a bogie with a track profileaccording to an example embodiment of a track-based transport system ofthe present invention;

FIG. 42 depicts a bogie configured to be removed or loaded onto a trackof a track-based transport system of example embodiments of the presentinvention;

FIG. 43 illustrates a track system for a transport device according toan example embodiment of the present invention;

FIG. 44 illustrates a nurse server according to an example embodiment ofthe present invention;

FIG. 45 illustrates a nurse server according to another exampleembodiment of the present invention;

FIG. 46 illustrates a nurse server according to yet another exampleembodiment of the present invention;

FIG. 47 depicts the overpacks and access provided thereto within thenurse server of the embodiment of FIG. 46 ;

FIG. 48 illustrates a nurse server according to a further exampleembodiment of the present invention;

FIG. 49 illustrates a nurse server user interface according to anexample embodiment of the present invention;

FIG. 50 illustrates a nurse server according to yet another exampleembodiment of the present invention;

FIG. 51 illustrates an example embodiment of a nurse cart supplied byproximate storage according to the present invention;

FIG. 52 is a schematic illustration of a user terminal according to anexample embodiment of the present invention;

FIG. 53 illustrates a car for a track-based transport system accordingto an example embodiment of the present invention;

FIG. 54 illustrates a clip for holding a medication overpack accordingto an embodiment of the present invention;

FIG. 55 illustrates a carrier configured to carry a plurality of clipswith overpacks according to an example embodiment of the presentinvention.

FIG. 56 illustrates a track-based transport system for carriers ofoverpacks on clips according to an example embodiment of the presentinvention;

FIG. 57 illustrates an example embodiment of a reader and releasemechanism for use with the clips of the example embodiment of FIG. 54 ;and

FIG. 58 is a flowchart of a method for transporting medications from acentral pharmacy to a patient in a healthcare facility according to anexample embodiment of the present invention.

DETAILED DESCRIPTION

Embodiments of the present invention may provide various apparatuses,systems, and methods for improving the efficiency of medicationdistribution within a healthcare facility. Some embodiments andcomponents of the present invention will now be described more fullyhereinafter with reference to the accompanying drawings, in which some,but not all embodiments of the invention are shown. Indeed, variousembodiments of the invention may be embodied in many different forms andshould not be construed as limited to the embodiments set forth herein;rather, these embodiments are provided so that this disclosure willsatisfy applicable legal requirements.

Further, example embodiments of the present invention may provide amethod, apparatus, and computer program product which may facilitatepredicting the medications needed by a patient over a period of time.While automation of the dispensing of medications within a healthcarefacility may improve efficiency of medication distribution,incorporating a mechanism to predict the medication needs for patientsmay allow automation to anticipate patient needs and to have medicationsreadily available for administration to a patient when the patientrequires the medications. Some medications for a patient may bepreviously prescribed such that they are known medications that will beneeded for a patient. Other medications that may later be prescribed maynot be known in advance of when they may be required. As such, a methodof anticipating the medications which may be needed may help to ensurethat medications are on hand when prescribed by a physician.

Embodiments of the invention configured to predict medications which maybe needed by a patient may predict the medication based on a number ofcriteria. For example, the medications which may be needed by a patientmay be predicted based on a knowledge of the patient's ailment,plurality of ailments, or combination of ailments, and the predictedmedication may be based upon a conventional medication regimen for thatailment, plurality of ailments, or combination of ailments. Further, themedication regimen for the ailment, plurality of ailments, orcombination of ailments may be physician specific, such that themedication regimen for ailments may be varied based upon the physiciantreating the patient. As a basic example, a patient with heartburn maybe treated by one physician with a histamine antagonist medication whileanother physician may prefer proton pump inhibitor medication. Themedication predicted for a particular patient may be dependent upon thepreferences and/or historical information about the physician treatingthem.

Another criterion that may be used to predict medications which may beneeded by a patient over a particular period of time may include ahistorical record of medication administered to the patient. Forexample, if a patient has a chronic condition and is on a maintenancemedication, embodiments of the invention may predict that the patientwill require their maintenance medication over the particular period oftime. Further, a patient may have a historical record of medicationstaken for a particular ailment, such as in a prior visit to thehealthcare facility. In such an embodiment, the record of the priorvisit, the prior ailment, the prior medication administered, and theefficacy of the medication may each be considered.

While the aforementioned criteria are primarily historical correlationsused for prediction of medication anticipated to be needed, additionallyor alternatively, embodiments of the invention may implement analgorithm to predict the medication which may be needed by a patientover a predefined period of time. For example, if a patient has acombination of symptoms and/or particular abnormal vital statistics(e.g., pulse, temperature, cholesterol, blood sugar, etc.), an algorithmmay take each of these variables into consideration to determine apredicted medication or medication regimen that the patient will needover a particular period of time.

Medications may also require specific supplies to accompany themedication such that supplies may be predicted in the same manner asmedications. For example, if a medication is administered intravenously,a syringe may be a required supply to accompany the medication. As such,when the medication is anticipated to be needed, a syringe is alsoanticipated to be needed. Alternatively, the supply could be predictedwhen a medication is ordered.

While the prediction of medication which may be needed by patients overa particular period of time may increase efficiency of medicationdistribution, having the predicted medication ready for dispensing at ornear the patient's location may further increase the efficiency ofmedication dispensing and administration. Such prediction and staging ofmedication may increase the efficiency of an authorized medical person,such as a nurse. For example, staging a medication proximate a patientand dispensing a medication to an authorized medical person proximatethe patient may reduce the time needed for the authorized medical personto walk to retrieve medications and wait for their delivery. By reducingthe time spent retrieving medications, additional time is afforded to anauthorized medical person for administration of the medication or forcare of a patient. This additional time may allow for higher qualitypatient care and less time spent in non-value added tasks of trackingdown needed medications and supplies for a patient. Additionally,automating all or part of the distribution of medication in a healthcarefacility may increase medication accuracy by providing automatedverification of the medication type and dose at various stages of thedistribution process.

Example embodiments of the present invention may provide variousapparatuses, systems, and methods which may automate or partiallyautomate some or all of the process of medication fulfillment anddelivery from a central pharmacy to a patient. Embodiments may beimplemented in full or in part to increase the efficiencies of thecomplex process of dispensing medications to a patient. As such,components described herein can be used individually or in combinationwith one another to achieve an automated or partially automated systemfor dispensing medications and supplies.

While embodiments of the present invention may be described with respectto healthcare facilities, such as hospitals and long-term carefacilities, for example, embodiments of the inventions described hereinmay be implemented in a variety of types of facilities, not limited tothose explicitly described herein.

Healthcare facilities may include a central pharmacy in whichmedications are stored and dispensed to areas throughout the healthcarefacility. Some healthcare facilities may rely on a supplier,distribution center, or remote central pharmacy which stores medicationsand supplies at a remote location and delivers the medications andsupplies on an as needed basis. In such an embodiment, the medicationsfrom the supplier, distribution center, or remote central pharmacy maybe received by a healthcare facility at a receiving area. Whileembodiments of the present invention may be described as transportingand dispensing medication from a central pharmacy, embodiments in whichcentral pharmacies are located remotely or embodiments usingdistribution centers may implement embodiments of the inventions fromthe area in which medications and supplies are received from the centralpharmacy or distribution center. The indication of medicationsanticipated to be needed may be provided to the central pharmacy ordistribution center with sufficient lead time such that the healthcarefacility may receive the medications in advance of when they areanticipated to be needed.

In some example embodiments of the present invention, medications may bereceived from a remote central pharmacy in overpacks (described furtherbelow) or packaged into overpacks in a local central pharmacy. Overpacksmay be means for packaging medication into a package that is moreconducive to automated handling. The overpacks facilitate uniformhandling to ease distribution and tracking within a healthcare facility.The medications in overpacks may be grouped together according to theirdestination, and the grouped overpacks may be transported to theirdestinations. The destination for the medication may include a unitstorage device which may serve as local storage for medication to avoidhaving authorized medical personnel walk between their healthcarefacility unit and the central pharmacy to retrieve medications. Whilestoring medication locally in a healthcare facility unit may allowauthorized medical personnel to retrieve medication locally fordispensing to patients on the unit, additional automation to deliver themedication closer to the patient may be implemented to further increasethe efficiency of medication distribution in the healthcare facility.

Medications located in the unit storage may be individually selected andtransported by an automated system to a location proximate to a patient,such as a patient server or a nurse server. A nurse server, according toexample embodiments as will be described further below, may be alocation situated close to a number of patients for which a nurse isresponsible. The nurse server may receive medications only for thosepatients and may have controlled access restricted to authorized medicalpersonnel. Similarly, the patient server of example embodiments may bedisposed at a location proximate to a patient and be configured toreceive medications only for that patient. The patient server may alsohave access restricted to authorized medical personnel.

Transport from the unit storage to the nurse server or patient servermay be accomplished in a number of ways as outlined further below.Medications, which may be contained in overpacks, as described furtherbelow, may be selected from the unit storage by a retrieval device, andsubsequently loaded onto a transportation device configured to transportthe medications to a location proximate to the patient for whom they areintended. The transport device may include a train, a shuttle, apneumatic tube system, etc.

Upon arrival of the medication at the nurse server or patient server,the medication may be unloaded from the transport device, oralternatively the transport device may remain with the medication at thenurse server or patient server. The medication may then be consideredstaged for retrieval by authorized medical personnel. The staging ofmedication may be, for example, in an overhead storage area disposedproximate a ceiling above the nurse server or patient server, awaiting arequest for dispensing. The authorized medical person, which may be anurse, technician, physician, etc., may be alerted that the medicationfor a patient is staged at the nurse server or patient server. When theauthorized medical person is ready to administer the medication to thepatient, they may access the nurse server or patient server, and theymay be required to provide authentication, such as an identificationcard, an identification PIN, a biometric scan (e.g., retina, fingerprint, hand geometry, palm vein, facial recognition, or voice analysis).In response to authentication of the authorized medical person, themedication may be dispensed from the staging area to the nurse server orpatient server for retrieval by the authorized medical person. Uponretrieval, the medication may be administered to the patient.

While the above description provides a general summary of some of theelements and operations of example embodiments of the present invention,certain elements and operations will be described further below.

Products to be Dispensed

Medications dispensed from a central pharmacy may be of a variety ofform factors from individual pills or capsules to intravenous bags of aliter or more capacity. Other form factors may include syringes,carpujects, vials, etc. Supplies, such as intravenous medication tubing,empty syringes, etc. may be dispensed from a separate medical supplydistribution center within a healthcare facility, or in some cases, thecentral pharmacy and medical supply distribution operations may becombined. Both the supplies and the medications may come in a variety ofsizes and shapes and may not easily and efficiently be transported inuniform containers throughout a healthcare facility. For example, acarpuject, ampoule, or a vial may be relatively fragile while a unitdose of a medication, such as a tablet, may be relatively durable. Whilethe tablet may be stored and dispensed in a very small package withoutsubstantial protection from transport, the vials, carpujects, andampoule may require larger, more durable packaging. Similarly,intravenous medication bags may be durable for transport, but may beeasily punctured such that care must be taken in storing, handling, anddistributing such products.

While certain medications are configured to be dispensed in vials wherea syringe is a required supply to accompany the vial, other medicationsmay require a patient to consume food or a beverage other than water. Insuch cases, the food or beverage to accompany the medication may betreated as a supply, and such supplies may also be dispensed as othersupplies may be dispensed as described herein.

In order to provide a more uniform form factor for medications andsupplies to be handled and dispensed throughout a healthcare facility,overpacks or packaging that encases or holds the medications or suppliesmay be used which provide a common size, profile, shape, or graspingfeature. Provided herein are various embodiments of uniform orquasi-uniform overpacks or secondary packaging for use with a variety ofmedications and supplies with varying shapes, sizes, and handlingrequirements (e.g., fragile, temperature sensitive, etc.). The overpacksdescribed herein may provide an aspect of uniformity to generallynon-uniform form factors. The uniformity may be in the profile of theoverpack, such as when the overpack includes a plurality of varioussized bins with uniform profiles, or the uniformity may be in alocating/holding hole of a plurality of various sized bags configured tohold the various form factors.

FIG. 1 illustrates an example embodiment of an overpack according toexample embodiment of the present invention using bins of varying sizeswith a common profile. Each of the illustrated bins 102, 104, 106, and108 are of a different size while maintaining a common profile. Thesmallest bin 102 may be configured to hold small items such as unitdoses of oral medication 110 (e.g., pills, capsules, tablets, etc.)while the largest bin 108 may be configured to hold large items such asa one liter intravenous bag 112 and/or intravenous tubing 114, each ofwhich may be too large to fit into any of the smaller bins 102, 104, or106. The bins between the largest and the smallest (bins 104, 106) maybe appropriately sized to hold medications and/or supplies such asvials, syringes, 100 mL intravenous bags, or the like. The uniformprofiles of the bins may allow the bins to be processed along a conveyorline configured to accommodate such a profile. Further, the uniformprofile bins may be stored on common shelves with only the width of theshelf occupied varying between bins of different sizes. While someembodiments of bins of varying size may include a variable length, otherembodiments may include a common length and a variable depth. Forexample, each bin may occupy the same width of a shelf, but the bin mayextend further back on the shelf to create added capacity.

In some example embodiments, the overpacks may be sealed or closed tokeep the contents of the overpack protected and/or secure. For example,the various sized bins of FIG. 1 may include lids which may be securedto the bins by a hook-and-loop fastener system, a snap-on lid, or a heator ultrasonically welded plastic film seal. The type of closure used forthe overpack may be dependent upon the use of the overpack. For example,an overpack for manual distribution (e.g., via a nurse cart) within ahealthcare facility may not require a closure, or may use a simplesnap-on closure. An overpack for automated distribution within ahealthcare facility, or an overpack for distribution through anover-the-road delivery service may require a more secure closure that isless likely to be inadvertently opened, such as a heat-sealed filmclosure.

The closure may also depend upon the type of contents contained withinthe overpack. For example, if the overpack contains environmentallysensitive contents that should not be exposed to humidity or moisturemay benefit from a heat-sealed film closure. Closures that areimpervious to air and moisture may also be used for overpacks used withoxygen sensitive contents where an inert gas fills the overpack.

A closure for an overpack may also be selected based upon whether thecontents are government regulated, as in the case of controlledsubstances, or if the contents are a high-value candidate for theft. Insuch embodiments, a lockable closure may be used to seal the overpack.FIG. 2 illustrates an example embodiment of an overpack with a hingedclosure. As illustrated, the overpacks 120 of FIG. 2 may include acommon profile, but have varying widths to accommodate medications andsupplies of various sizes. The overpack base 122 and hinged lid 124 mayopen in a clamshell fashion to allow access to the interior cavitycontaining the medication or supply. As shown, the overpack may includea divider 126 which may allow two articles to be carried within oneoverpack without the two interfering with one another. The separationafforded by the divider may help to reduce confusion or mistakes whenmultiple medications are contained in an overpack for a particularpatient. Also illustrated in the overpacks of FIG. 2 are a closuremechanism including a tab 130 received within latch 128. The closuremechanism may be a locking mechanism requiring a key, code, or biometricidentifier. For example, authorized medical personnel may have access toa key, such as a magnetic key kept on their person or at a nursestation, which may unlock the latch 128. Optionally, the latch may be apush-button release configured only to maintain the lid 124 in a closedposition during transport. While closures and locks may be used tosecure controlled substances, security of controlled substances mayadditionally rely upon security by obscurity, in which narcotics andother controlled substances are not distinguished from non-controlledsubstances, such that locating controlled substances among the pluralityof medication overpacks may be difficult.

FIG. 3 illustrates another example embodiment of an overpack. Theillustrated embodiment of FIG. 3 is a reusable folding pouch styleoverpack which may be available in various sizes to accommodate multiplesizes of medications and supplies. The pouch 132 may be made of apliable material 134 which may be elastic to better hold the contentswithout shifting. The material may also be substantially transparent toallow easy verification of the contents of the pouch. The material 134may have an adhesive strip 136 around the perimeter such that when thesheet of material 134 is folded, a pouch 132 is formed. The adhesivestrip 136 may be a hook-and-loop type fastener or a releasable adhesivematerial to allow the pouch to be easily opened and reclosed for reuse.Optionally, the pouch style overpack may be designed for a single-useand may include a non-releasable adhesive requiring the pouch 132 to betorn open. Such a single-use type pouch may be beneficial forembodiments requiring evidence of tampering. The pouch 132 may alsoinclude a loop 138 or hook which may be used to hang or grasp the pouchin transport and dispensing. As outlined above, some overpacks mayinclude a common sized and/or shaped grasping feature, such as the loop138 to aid automation or efficient handling as opposed to, or incombination with, a common size or profile.

Overpacks according to the present invention may be embodied in otherforms, such as envelopes or bags. FIG. 4 illustrates an exampleembodiment of an overpack in the form of a bag 140 including a hole 142.The bag type of overpack may be of any necessary size to accommodate themedication or supplies carried therein, and the hole 142 may be used forholding, storing, and grasping the bag 140. The bag or envelope styleoverpack may be conducive to use in instances where the medication orsupply is received from a supplier as the cost of the overpack andmaterial used therein is relatively minimal. Further, pharmacyautomation tools, such as an automated dispensing system, may beconfigured to package and dispense medications and supplies in suchoverpacks, such that manual packaging of the medications or suppliesinto overpacks may not be required, thereby increasing efficiency andreducing cost. Some medications may be available from a supplier in bulkquantities in such overpacks, such as the illustrated box 144 of unitdose blisters 146 supplied in bag style overpacks 140.

FIG. 5 illustrates another example embodiment of overpacks according toembodiments of the present invention. The illustrated embodimentincludes various sizes of boxes, ranging from a small box 147 to a largebox 148. The small size and the large size may be dictated by the sizesof medications and supplies to be handled within a healthcare facility.In the illustrated embodiment, the boxes 147, 148 include hinged doorson a front side of the box. The doors may be hinged proximate the bottomof the front, opening outward. The boxes may include a common depth suchthat the boxes may be arranged in a stacked configuration 149 while eachof the doors to each of the boxes remain accessible.

Overpacks according to embodiments of the present invention may alsofacilitate automation of medication order fulfillment. For example, asillustrated in FIG. 6 , empty bins 160 of various sizes but of a commonprofile may be configured to be transported along a conveyor 162 and befilled by a robot 164 or other form of automation. The robot 164 mayplace a medication or supply 166 into the bin 160 for dispensing to apatient. Embodiments of the present invention may also be used withexisting automated pharmacy dispensing systems, such as Robot-Rx™ fromMcKesson® which may distribute medications from an inventory to anoverpack for transport to a location proximate a patient.

Overpacks may be configured to contain only a single medication (i.e., aunit dose), a medication and a related supply (e.g., a vial ofmedication and a syringe), or the overpacks may be configured to containmultiple medications destined for the same patient. For example, if apatient requires five medications in the morning, three in the middle ofthe day, and four medications in the evening, an overpack may be filledwith the five morning medications, a second overpack may be filled withthe three middle-of-the-day medications, and another overpack may befilled with the four evening medications. In such an embodiment,individual tracking and control over unit dose medications may be lost;however efficiencies may be gained by using only a single overpack foreach time of day that medication is required for the patient.

According to some embodiments of the present invention, overpacks mayalso include identifying indicia disposed thereon for identifying thecontents of the overpacks. In one embodiment, the overpacks may includean overpack identification number which is correlated with a medicationor supply that is placed into the overpack. The correlation between theoverpack identification number and the contents may be performed by anautomated system that loads the overpacks. Such a correlation wouldallow an overpack to be scanned to determine the overpack identificationnumber, and then referenced in a database to determine the contents ofthe overpack without requiring a person to review the contents of theoverpack. The database may be maintained by a server in the healthcarefacility configured to track and monitor medication dispensing withinthe healthcare facility.

According to another embodiment, the overpack may include a label thatis written to for denoting the contents of the overpack. FIG. 7illustrates an example embodiment of a patient identification label 172that is printed and paced into an overpack 170. The illustrated overpackmay be a blister pack, bag, or envelope configured to receive amedication unit dose. The overpack 170 may further be configured with ahole 174 for uniform storage and retrieval. While illustrated as apatient identification label 172, the label attached to an overpack mayidentify the contents of the overpack without regard for a specificpatient. In the illustrated embodiment, the patient identification labelmay include a barcode or other indicia identifying the patient and thepatient identification label 172 may be inserted into a pocket orotherwise affixed to the overpack 170. The identification may also beprinted directly onto the overpack material rather than onto a separatelabel.

FIG. 8 illustrates an example embodiment of the overpack 170 as carriedon a rod 176. The overpack 170 may be carried on the rod 176 forautomated distribution, transport, or storage. While the illustratedpatient identification label 172 includes a barcode and name,embodiments may include a patient or overpack contents label thatincludes a radio frequency identification (RFID) label configured to beread by an RFID reader exclusive of or in addition to other identifyingindicia, which may include barcodes, text, or other human or machinereadable information. In some embodiments, the label 172 may include animage of the medication that is supposed to be contained within theoverpack 170 to allow authorized medical personnel to visually confirmthe contents of the overpack are correct. While identifying indicia maybe printed to a label, embodiments of the present invention may includeoverpacks using electronic ink labels. Electronic ink labels may be“printed” by programming such that when a medication or supply is loadedinto an overpack the electronic ink label is programmed to displayidentifying indicia about the medication or supply contained within theoverpack. Electronic ink labels may function in the same manner asconventionally printed labels (e.g. by thermal printing, ink jetprinting, laser printing, etc.) such that they may be read by a user orby a reading device.

Additionally or alternatively, medications, such as blister packs mayinclude identifying information printed to the blister pack. Overpacksmay be configured such that the identifying indicia of the medicationpackaging is readable through the overpack. For example, a blister packwith identifying information thereon may be placed into a bag throughwhich the blister pack may remain readable.

Input Organization

Medications or supplies, whether packaged in overpacks as outlinedabove, or in their native containers (such as blister packs for pills orintravenous bags), may be stored and transported within the healthcarefacility. Storage of the medication and supplies may be within thecentral pharmacy or at a unit storage device. While the central pharmacymay supply medications and supplies to an entire healthcare facility, aunit storage device may be located remotely from the central pharmacyand may be configured to store medications and supplies only forpatients serviced in a particular unit of the healthcare facility aswill be described in further detail below. As such, there may bemultiple unit storage devices within a healthcare facility.

Transporting or moving medications and supplies within a healthcarefacility is inefficient when the medications are moved individually orwithout regard for other medications that are bound for the same or asimilar destination. As such, logistics may be implemented to optimizetransport and to efficiently move groups of medications to commonlocations, such as unit storage devices, within a healthcare facility.Software may be used to group together a plurality of medications orsupplies in overpacks to be sent to the same location. The software maybe implemented on a user terminal, as described further below, or acrossa network of a healthcare facility. The software may determine whichoverpacks are to be grouped, and route them to their appropriatedestination. As described herein “routing” of medication and supplieswithin a healthcare facility includes generating a route or a plannedroute for the medication and supplies. Routing is generally provided bysoftware, while the physical transport of the medication and supplies isperformed by hardware, or in some cases, people. For example, a routemay be established for an individual unit dose in an overpack; however,that overpack may be transported together with other overpacks that havethe same, or a portion of the same route.

Embodiments of the present invention may provide means for organizingmedication and/or medication overpacks for efficient transportation fromthe central pharmacy. In order to efficiently move medications andsupplies or products within a healthcare facility, the medications andsupplies may be organized into groups of medications and supplies thatare bound for the same general location, such as the same unit storagedevice. Further, individual accessibility to, or identification of eachof the medications or supplies that are within a group may be desirable.Once the medications and supplies arrive at their common destination,they may need to be placed into a unit storage device or otherwisedistributed as appropriate. Therefore, organization of the medicationsand supplies for transport to the unit storage devices may increaseefficiency of retrieval and local storage of the medication andsupplies.

Provided herein are methods and apparatuses to organize and transportmedication and supplies from a central pharmacy or from a remotepharmacy and/or from a central supply storage location to local storage,such as at a unit storage device. The manner in which the medicationsand supplies may be organized for transport may facilitate automationand enhance the efficiency of their distribution.

Commonly used medications, such as aspirin, may be provided incartridges or magazines where individual unit doses of medication areavailable to be dispensed from the magazines. The magazines orcartridges may be configured to be received by a local storage device(e.g., a unit storage device) for distribution on an as-needed basis.Magazines and cartridges allow for a high volume of storage in arelatively compact form factor. The shape of the medication package oroverpack may also allow for efficient one-at-a-time distribution of themedication from the magazine or cartridge. Dispensing may be performedfrom the bottom of a magazine or from the top using a variety ofmechanisms to singulate a unit dose or unit dose package of medicationfrom the plurality of unit dose packages of medication within themagazine. Cartridges may also contain rolls of unit dose medication withindividual packages and perforations therebetween.

An example embodiment of a magazine is illustrated in FIG. 9 . Theillustrated embodiment depicts a medication package 60 which may includea unit dose of medication. The illustrated medication package 60 may beconducive to automated handling and may not require an individualoverpack; however, in some embodiments, such as overpacks includingvarious sizes of bins, the medication package 60 may be dispensed to aan overpack bin for automated transport. The medication package 60 mayinclude a medication name, dose, lot number, expiration date, or anysimilar identifying indicia. The indicia may be in the form of text,barcode, or an RFID tag. A plurality of medication packages 62 may bestacked and inserted into a magazine 64. The cutaway of the magazine 64illustrates the plurality of medication packages 62 disposed inside. Themagazine 64 may be filled at a central pharmacy, or the magazine mayarrive at the central pharmacy previously loaded with unit dosemedications ready for dispensing. A medication package 68 at the bottomof the stack of medication packages 64 may be arranged proximate anopening 66 in the magazine 64, ready to be pushed or drawn out of themagazine 64.

Systems according to example embodiments of the present invention mayinclude a device configured to remove a medication package 68 from amagazine 64 automatically in response to an indication for a need forthe medication; however, magazines of example embodiments may also beimplemented in manual-fill operations where a user may pull a medicationfrom the magazine. Example embodiments of automated systems fordispensing medication packages from magazines are detailed furtherbelow.

Another example embodiment of an apparatus for packaging commonly usedor as-needed medications may include a “sausage-link” type package asillustrated in FIG. 10 . The sausage-link overpack 10 may include a tubeof material, such as plastic, which may receive a unit dose ofmedication 14 and be crimped 16 on either side of the unit dose. Thetube may be structured, such that it holds its shape as in the case of amaterial such as low-density polyethylene (LDPE), or it may be aflexible film, such as polyvinylidene chloride (PVDC). The crimping maybe performed, for example, by heat or ultrasonic welding of the tubematerial between the unit doses of medication 14. The crimps 14 mayfurther include perforations or other structurally weakening features toallow for easy separation of a unit dose links. A plurality of linkedunit dose links may be stored in a spool or accordion style magazinesuch that a link may be pulled out, separated, and the next linkcontaining a unit dose medication 14 is ready for use. The sausage-linktype package may include indicia written thereon, and/or thesausage-link type package may include a blister pack therein which mayhave identifying indicia written thereon. The indicia of the blisterpack may be readable through the sausage-link type packaging such thatadditional indicia may not be necessary.

Packaging of medications that may be stored in bulk in unit storagedevices may also include a two-dimensional array of unit dose packagesadhered to a backing. For example, a backing with a releasable adhesivemay receive thereon a plurality of unit dose medications, such asblister packs of pills. When a unit dose is needed, a nurse or otherauthorized medical person may remove one or more of the unit doses fromthe two-dimensional array as needed.

While some medications and supplies may be stored locally on healthcarefacility units for use as-needed, such as aspirin, bandages, alcoholswabs, etc., other medications and supplies may be distributed tohealthcare facility units only in response to a perceived or actualpatient need, as described above with regard to predicting medicationswhich may be needed by a patient. In order to distribute medicationswithin the facility based upon an indication that the medication may beneeded, medications and supplies may be grouped with other medicationsand supplies bound for the same healthcare facility unit to betransported to the healthcare facility unit. An example embodiment ofsuch a grouping may include trays configured to hold a plurality of binsas described above with regard to the bins 102, 104, 106, and 108 ofFIG. 1 . FIG. 11 illustrates an example embodiment of a plurality ofbins 150 of various sizes, but with a common profile, that may be loadedonto a tray 152. The plurality of bins 150 may also be covered, as aunit, with a single lid 154. The lid 154 may be exclusive of, or inaddition to individual closures on the individual bins 150 themselves.The lid 154 covering all of the bins 150 may provide security to thebins 150 to maintain them in position on the tray 152 during transport,and the lid 154 may discourage or prevent removal of an individual binfrom the tray when the tray is between the central pharmacy and thelocal storage.

The tray 152 of example embodiments may be sized and shaped toaccommodate a plurality of overpacks and to hold them securely toprevent shifting of the overpack during transport. As shown in FIG. 11 ,the tray 152 is configured to receive a plurality of bins 150 withvarying sizes. In order to maximize the use of the tray 152 and to helpprevent shifting of the bins 150 within the tray, the bins may fullyoccupy the tray. Since there are bins 150 of varying sizes, somecombinations of bin sizes will fully occupy the tray 152, while otherswill fall short of occupying the full tray. A software program may beconfigured to direct the bins that go on each tray to maximize the useof each tray. For example, a software program may recognize 50 bins thatare to be transported to a particular healthcare facility unit. Thesoftware may analyze the size of each bin and compile groups of binsthat fully utilize trays to maximize the tray use and increase theefficiency of the transportation. The software may be configured toprovide information to a person who is manually loading bins 150 ontothe tray 152, or alternatively, in an automated loading system, thesoftware may direct the placement of specific bins on specific trays byan automated loading mechanism which loads the bins into the trays. Onceloaded, the trays are ready to be transported to their destinations. Thetray 152 may have features at regular intervals, such as slots, detents,or dividers to prevent bins 150 from moving or shifting while on thetray.

The software described herein may be part of a suite of software or asoftware with a plurality of functions including: predicting theanticipated medications which may be needed by patients; loadingmedications and supplies into overpacks; grouping overpacks fortransport to local storage; establishing a route for overpacks to theirappropriate destination; directing transport of the overpacks toproximate storage; and dispensing medications and supplies. The softwaremay perform some or all of these functions while tracking eachmedication throughout the healthcare facility. The software may furtherbe combined with other software used for administering medications andtracking overall inventory counts.

FIG. 12 illustrates an example embodiment of a system configured to loadoverpacks and group the loaded overpacks onto a tray or cassette. In theillustrated embodiment, a medication unit dose 20, such as a blisterpack, may be scanned using a reader to identify the medication bybarcode, RFID tag, or other identifying indicia of the unit dosemedication. The scanning may be performed automatically or manually by auser. Upon scanning, the software that recognizes the identity of themedication unit dose 20 may identify the appropriate bin size. Forexample, a unit dose blister may require only a small bin, while a 100mL IV bag may require a large bin. The software may present theappropriate size bin to the user, direct the user to the appropriatebin, or simply indicate to the user the bin size appropriate for themedication unit dose via a user interface. In the illustratedembodiment, an empty bin 22 of the appropriate size is pulled from acassette 24 containing bins of the appropriate size. Other cassettes 26,28 may contain bins of other sizes. The user may then place the unitdose medication 20 into the selected bin 22. Each bin may include uniqueidentifying indicia thereon, such as a serial number, which may bescanned to correlate the medication placed therein with the overpackserial number. Subsequent scanning of the overpack may reference adatabase to determine the medication that is associated with thatparticular overpack. Additionally or alternatively, a label may beprinted or electronically written to for the overpack such that theoverpack may have a label identifying the contents of the overpack.

As shown in FIG. 13 , after the unit dose medication 20 is placed intothe bin 22, the bin 22 is loaded into the back of the cassette 24 fromwhich it was dispensed. The user may continue to scan medication unitdoses and load them into bins until any of the cassettes 24, 26, 28 arefull (i.e, no more empty bins). The full cassette may then be loaded toa transport device, such as a transport cart as described further below,for transport to a unit storage device.

FIG. 14 illustrates another example embodiment of a system for loadingoverpacks. In the illustrated embodiment, a unit dose medication 30 isscanned by a reader 32 configured to read one or more of a barcode, anRFID tag, or other identifying indicia. The identified unit dosemedication may be displayed on user interface 34 allowing a user toconfirm the identity of the medication. The user interface 34 maydisplay information regarding the unit dose medication including animage thereof such that a user can confirm that the unit dose medicationmatches the displayed image. An appropriately sized bin may beautomatically selected based on the unit dose medication identified andthe appropriate bin 36 may be sent along conveyor 40 from a plurality ofbins of varying sizes 38. Identifying indicia on the bin may be scannedupon being transferred from the plurality of bins such that the identityof the bin (e.g., a serial number) may be correlated to the unit dosemedication that is loaded into the bin. In such a manner, the unit dosebin may be associated in a database with the medication containedtherein, such that identification of the bin anywhere within thehealthcare facility may also identify the contents, including suchinformation as medication type, dose, expiration date, etc. The unitdose medication may then be loaded into the bin 36 as the bin isadvanced to a device to load the bin onto a transport device (e.g., acart, pneumatic tube, elevator, etc.).

Another example embodiment of loading unit dose medications into binsmay be similar to that illustrated in FIG. 14 ; however the system mayallow loading of multiple bins with the same type/dose of medication atthe same time to increase efficiency. For example, if a user has sevenunit doses of a particular medication, the first unit dose may bescanned by reader 32, and a quantity of unit doses may be entered on theuser interface 34. Subsequently, the corresponding number ofappropriately sized bins 36 may be transferred from the plurality ofbins 38 to the conveyor 40. The user may then load all of the binssubstantially simultaneously to increase efficiency by reducing the timerequired.

FIG. 15 illustrates an example embodiment of filling bins with unit dosemedications automatically. A magazine 44 may be loaded with a pluralityof unit dose medications 42. The magazine 44, and/or the medicationsstored there in 42 may include identifying indicia to identify themedication unit doses. Each magazine may include an orifice 46 throughwhich the unit dose medications 42 are dispensed. A carousel 48 mayinclude a plurality of magazines 50 disposed about the carousel 48. Anautomated dispenser 52 may be configured to dispense unit dosemedications 42 from the plurality of magazines 50. As the carousel 48rotates, different magazines 50, containing different unit dosemedications (or optionally, additional supplies of a frequently usedunit dose medications) may be rotated into alignment with the dispenser52 for dispensing to unit dose bins 54 advancing along conveyor 56. Thebins 54 may be identified by a reader configured to read identifyingindicia from the bins and a database configured to correlate thedispensed unit dose medication with the appropriate bin. A userinterface 58 may be provided to allow user monitoring, auditing, andintervention when necessary. In the example embodiment of FIG. 15 , bins54 may be loaded substantially automatically with little to no userinput required.

FIG. 16 illustrates an example embodiment of an apparatus to organizeand transport medication and supplies from a central pharmacy or from aremote pharmacy to local storage. The embodiment of FIG. 16 illustratesa unit dose of medication 180, which may be loaded into an overpack, inthis case, a bag 184 using a bag filling device 182. The bag 184 maythen be loaded into a clip of a carrier 188. The illustrated carrierincludes a plurality of clips (not shown) which each hold a bag 186 typeoverpack. Rather than a tray as illustrated in FIG. 11 , FIG. 16 uses acarrier in which the bags are suspended. As will be appreciated, thecarrier can accommodate items of various sizes by receiving varioussized bags within the clips. Alternatively, as illustrated in FIG. 17 ,items that are very large may be suspended by more than one clip. Thecarrier 188 of FIG. 17 is illustrated carrying a large item in a bag 190with both ends of the bag suspended within clips 192.

Another example embodiment of organization of the overpacks inpreparation for transport to a unit storage device may include bag-typeoverpacks that are disposed on a rod. FIG. 8 illustrates an exampleembodiment of an overpack 170 that is carried by rod 176. The rod 176may be independently movable while holding a plurality of overpacks 170.For example, rod 176 may be received within a peg-board style apparatusfor storage or transport. The rod 176 may include medications inoverpacks for a single patient, and/or the rod may include medicationsfor patients in a particular location. One advantage to an inputorganization apparatus of this type may include that an automateddispensing system, such as Robot-Rx™ may be configured to automaticallyload medications onto the input organization apparatus in preparationfor distribution.

Transport to Unit Storage

According to example embodiments of the present invention, uponorganization of the medications and supplies in overpacks into groups,the grouped articles need to be transported to a location proximate thepatients, or at least closer to the patients than the central pharmacy,such as a unit storage device. The mode of transportation may varyaccording to the type of overpacks used, the type of input organizationused, etc. Provided herein are means for transporting medications and/oroverpacks from a central pharmacy to a unit storage device.

An example embodiment of an apparatus used for transportation from thecentral pharmacy to the unit storage device is illustrated in FIG. 18 inwhich a lidded tray 200 is received within a transport cart 202. Thelidded tray may be similar to that which is illustrated in FIG. 11 inwhich bins of varying size are received on a tray. While the illustratedembodiment shows a lidded tray 200, transport carts 202 may beconfigured to receive other types of overpacks and input organizationdevices.

The transport cart 202 may be configured with an RFID tag readerconfigured to read RFID tags associated with overpacks. In such anembodiment, the RFID tag reader or readers associated with the cart 202may read the RFID tags of each of the overpacks received within the cart202. Thus, the cart 202 may recognize the inventory stored therein fortransport to a unit storage device. In some embodiments, the cart 202may report the inventory via wireless communications to a network whichmonitors the location of the transport cart 202 and the contentstherein. As such, an inventory control system may be configured torecognize and track the location of each overpack and unit dosemedication or supply stored therein throughout the healthcare facility.Example embodiments of communication means and the networks over whichsuch a system may operate will be described further below.

Additionally or alternatively, trays 200 may include identifyingfeatures such as RFID tags, barcodes, or other identifying indicia.Embodiments of the present invention may “build” a tray of overpacks byidentifying the tray and filling the tray with identified overpacks. Insuch an embodiment, the tray may be tracked with an understanding of thecontents of that specific tray.

Transport carts according to example embodiments of the presentinvention may be configured to be secure storage of the medications andsupplies contained therein while transporting the articles from thecentral pharmacy to the unit storage devices. For example, asillustrated in FIG. 18 , each tray 200 may be configured to be receivedwithin a shelf 204. The tray 200 may be configured such that individualbins or overpacks may not be removed from the tray 200 without the lidbeing removed. The shelf may include features or may be sized such thatwhen a tray 200 is received within the shelf 204, the lid may not beremovable. As such, the individual bins or overpacks may not beaccessible without removing a tray 200 from the shelf 204. To preventunauthorized removal of a tray 200 from the shelf 204, the cart mayinclude a security feature to lock the trays into the shelves. The cartmay include a single security feature or lock to lock all trays withinall of the shelves simultaneously, or optionally, the cart 202 mayinclude individual locks 206 for each shelf 204. Individual locks 206for each shelf 204 may allow different authorized medical personnelaccess to different shelves. For example a medical staff person with afirst level of authority may be authorized to remove trays 200 that donot contain controlled substances, while a medical staff with a second,higher level of authority may be provided access to shelves with trayscontaining the controlled substances.

The security features of carts 202 of example embodiments, whether foran entire cart or for specific shelves 204, may be configured to requirea key, identification card, PIN, or biometric identifier to access thetrays 200. In example embodiments in which the cart 202 is incommunication with a network, a notification of access may be providedto the network in response to a tray being accessed. The notificationmay provide the identification of a user who accessed the tray toprovide an audit trail of the medication and/or supplies of the trayfrom the central pharmacy to the unit storage device.

Transportation of carts from the central pharmacy to the unit storagedevice may be performed manually or may employ automation, or acombination thereof. For example, the cart 202 of FIG. 18 may include adrive mechanism and guiding features that allow the cart 202 to be anautonomous guided vehicle. The guiding features may include an apparatusconfigured to detect guide wires disposed within a floor of a healthcarefacility, or the guiding features may include software with a functionalknowledge of a healthcare facility layout and an ability to navigate thehealthcare facility, among other autonomous guiding features.

In some example embodiments, the cart 202 may not include features toenable autonomous guidance and transport through the healthcarefacility, but an autonomous guided vehicle may engage the cart 202 andguide the cart to the destination. In such an embodiment, the autonomousguided vehicle may be a compact, relatively flat device which slidesunder the cart 202 and guides the cart from underneath, thereby notincreasing the footprint of the cart during transportation. In otherembodiments, an autonomous guided vehicle may engage the cart 202 from aside, and push the cart through a facility to its destination.

Transportation of overpacks to a unit storage device may also includeautomated loading and unloading of the overpacks to the unit storagedevice. For example, a transport cart may engage a unit storage devicewherein overpacks or a tray containing overpacks may be removed from thetransport cart by a retrieval device, as outlined below. Such automatedloading and unloading may allow transport carts to advance efficientlybetween unit storage devices without having to wait for manualunloading.

FIG. 19 illustrates another example embodiment of an apparatus fortransporting medications and/or supplies from a central pharmacy. Theillustrated embodiment of FIG. 19 depicts a cart 210 configured to carrya plurality of carriers 214. In such an embodiment, the carriers may besuspended from shelves within the cart 210. The cart 210 of the depictedembodiment includes sliding doors 218 which may prevent unauthorizedaccess by being lockable. Unlocking of the sliding doors may requireidentification of authorized medical personnel by identification cardscanning, biometric scanning, PIN entry, or keyed entry. As outlinedabove with respect to FIG. 18 , access to the cart 210 may be reportedto a network for tracking of contents therein and for an audit trailrelated to the handling of the medication.

Example embodiments of cart-based transport devices may also includeinventory stored thereon for replenishing as-needed medications andsupplies in a unit storage device. Such inventory may be used to restockmedications that have a low level of inventory at the unit storagedevice, or if expiring medications need to be replaced.

While the above embodiments describe cart-based transport from thecentral pharmacy to unit storage, other types of transport may beimplemented. For example, medication overpacks may be transported tounit storage devices along track based transport systems, tube basedtransport systems (e.g., pneumatic tubes), elevators, or other transportsystems which may be automated to varying degrees. Each of theseembodiments may transport one or more overpacks at a time in dependenceupon their implementation.

The efficiency of dispensing of medications and supplies within ahealthcare facility may be improved by delivering the medications andsupplies, including those that are known to be needed (e.g., previouslyprescribed) and those that are predicted to be needed, in groups to alocation closer to the patients than the central pharmacy. Thistransportation maximizes resources, such as transport carts, whileminimizing the required number of trips that must be made to delivermedications and supplies to units of a healthcare facility. Upon arrivalat the healthcare facility unit, the medications and supplies may bedispensed to a local storage device that may further enhance theefficiency of distributing the medications and supplies to the patients.

Unit Storage

As outlined above, in order to more efficiently distribute medicationsto patients in a timely manner, it may be desirable to store medicationsfor patients in a location closer to the patients than the centralpharmacy. Further, as the majority of medications are used during only aportion of the day (e.g., 9 am-5 pm), relying on the central pharmacy tofill and distribute all medication orders directly to the patients mayoverburden the central pharmacy during the peak hours. Providing remote,local storage of medications for specific patients, as afforded by thepredictive nature of example embodiments outlined above, allows acentral pharmacy to fill medication orders and distribute medicationsand supplies off peak hours, ahead of the peak need for the medications.In order to support this method of distribution, unit storage devicesmay be employed in areas of healthcare facilities, such as in nursingunits or hospital floors, for example. Embodiments of the presentinvention may include means for storing medications and/or overpacks ata location between the central pharmacy and the patient. The means forstoring medication may also be configured with means for user interfaceand means for dispensing of the medications from the storage means.

An example embodiment of a unit storage device 250 is illustrated inFIG. 19 in which medications and supplies are received at the unitstorage device 250 using input organization devices as outlined above.In the illustrated embodiment, carriers 212 with medications in bags 220may be received at the unit storage device 250 and loaded into theinterior 216 of the unit storage device. Each of the carriers 212 of theillustrated embodiment may be individually accessible within the unitstorage device 250 such that medications for a particular patient may beeasily accessed at any time. Further, when medications need to beremoved from a carrier, or an entire carrier requires removal from theunit storage device, the carrier may be directly accessed for easyremoval.

FIG. 20 illustrates another example embodiment of a unit storage device260 wherein a cart 270 transports trays 266 of overpacks 268, in thiscase various sizes of bins with a common profile. Upon removal of thetray 268 from the cart 270, the lid 264 may be removed, and theoverpacks 268 may be loaded into the shelves 262 of the unit storagedevice 260. In some embodiments, the overpacks 268 may be removed fromthe tray 266 before loading into the unit storage device 260, while inother embodiments, the overpacks 268 may remain on the tray 266 to allowfaster, more efficient loading.

As outlined above, the cart 270 may include features which allow thecart to report inventory to a network of the healthcare facility. Uponaccess to a tray 266 or carrier 212, the a communications interface ofthe cart 270 may provide an indication that a tray 266 or carrier 212has been accessed, and removed for loading into a unit storage device.Similarly, the unit storage device may be equipped with a communicationsinterface and an apparatus to detect the medications that are loadedtherein. In response to receiving a tray, carrier, or medication/supplyoverpacks, the unit storage device may provide an indication to thenetwork of the contents received therein for inventory tracking.

Unit storage devices according to embodiments of the present inventionmay have controlled access such that only authorized medical personnelmay access the contents of the unit storage device for loading,unloading, or accessing the medications and supplies stored therein.Access may be granted to an authorized medical person in response toidentification of the authorized medical person by identification card,PIN, biometric scan, or key. Further, the access may be reported via acommunications interface to the healthcare facility network asappropriate.

FIG. 21 illustrates another example embodiment of a unit storage device280 which may be loaded from a side of the unit storage device. In theillustrated embodiment, a tray of overpacks 282 may be inserted into aside 284 of the unit storage device 280 accessible through a door 286.One advantage to the illustrated unit storage device 280 may includethat it has a shallow depth relative to a wall. For installation of unitstorage devices into existing facilities, space in which to locate aunit storage device may be scarce. As such, when locating a unit storagedevice 280 in an existing hallway, a shallow depth may be imperative.Further, allowing the unit storage device to be loaded from a side 284may allow the unit storage device to be loaded without encroaching intothe hallway.

Unit storage devices of example embodiments may be configured to storemedications and supplies in overpacks specifically designated forindividual patients and they may be configured to store bulk medicationswhich are not designated for individual patients. For example, a unitstorage device may include the predicted medications for the patients ina unit of a healthcare facility needed over a particular period of time;however, certain as-needed medications may not be included in thepredicted medications. Medications such as aspirin, antacids, etc. maybe stored in unit storage devices for dispensing on an as-needed basis.Such medications may be provided to an authorized medical person at theunit storage device, or transported to a nurse server or patient serveras detailed further below. The as-needed medication may be stored withina unit storage device in magazines, cartridges, spools of unit dosepackages (e.g., separated by perforations), or the like.

Unit storage devices according to embodiments of the invention may havean inventory monitor or control, which may be implemented at the unitstorage device, or remotely implemented configured to monitor inventoryand information about the medication stored within the unit storagedevice. In this manner, the inventory monitor may monitor medicationsstored in the unit storage device for patients, and monitor inventoryinformation regarding as-needed medication and supplies. For example,as-needed medications and supplies stored within the unit storage devicemay include lot numbers, manufacture dates, expiration dates, or thelike. Inventory levels may be monitored for purposes of reorderingmedications and/or supplies to be delivered to the unit storage device.The inventory monitor may be configured to monitor a plurality of unitstorage devices and monitor the use of particular medications orsupplies at the various unit storage devices.

Medication that may be stored in unit storage devices for use on anas-needed basis, as opposed to patient-specific medication, may bestored in a unit storage device for a period of time. During storage, aparticular as-needed medication may approach an expiration date. Inresponse to approaching the expiration date, an inventory monitor mayevaluate other unit storage devices to determine if any other unitstorage devices within a healthcare facility use the particularas-needed medication at a higher rate. For example, an intensive-careunit may use more pain medication than a cardiac unit. In response todetermining a higher rate of use of the particular as-needed medicationat another unit storage device, the inventory monitor may be configuredto direct a transfer of the medication approaching the expiration dateto the unit storage device with a higher use rate of that medication.Such a transfer may reduce waste of medications that have expired andmay reduce inventory costs.

An inventory monitor may also be able to predict upcoming shortages of aparticular medication. For example, an urgent care unit may have asupply of flu vaccines. In response to an increase in flu cases, theinventory monitor may determine an increased need for flu vaccines andpredict demand to outstrip current supply. In response, the inventorymonitor may initiate a request for additional flu vaccines to beprovided to the unit storage device. The request may be sent to acentral pharmacy, for example. Should the central pharmacy not havesufficient inventory to meet the demand, the inventory monitor mayinitiate an order from a remote facility or distribution center.

Unit storage devices according to example embodiments of the presentinvention may also be configured to provide refrigerated storage. Somemedications require refrigerated storage until they are ready to beadministered. According to embodiments in which medications aretemporarily stored at the unit storage device, such refrigerated storagemay increase the shelf life of the medication and may allow the unitstorage device to store refrigerated medications for a longer period oftime than otherwise possible.

FIG. 22 illustrates an example embodiment of a high-capacity unitstorage device 960. The illustrated embodiment includes two banks 962 ofshelves configured to hold a plurality of medication or supplyoverpacks. The overpacks of the illustrated embodiment may include acommon profile (e.g., frontal width and/or frontal height) while havingvarious sized depths to accommodate different sizes of items. Forexample, each of the overpacks may be a bin with a width of about fourinches, and the depths may be two, six, or twelve inches. The banks mayhave a depth of about 24 inches, and each bank may have a plurality ofcompartments 964 configured to receive the overpacks. Each compartment964 may hold overpacks totaling 24 inches in depth. In some exampleembodiments, overpacks may be grouped together in compartments of thebanks according to the patient for whom they are intended. Additionallyor alternatively, overpacks may be grouped together in compartments ofthe banks according to the size of the bins. For example, alltwelve-inch deep bins may be stored in a particular area of the banks,while six-inch and two-inch deep bins may be grouped in a respectivearea of the banks. A compartment may hold two twelve-inch deep overpackbins, four six-inch deep overpack bins, or twelve two-inch deep overpackbins.

The illustrated embodiment of FIG. 22 may further include storage ofblister packs separate from the common-profile overpack bins. In theillustrated embodiment, blister pack storage 968 may be configured tohold in each compartment a tray of unit dose medications, each stored ina blister pack. As blister-packs are relatively common form factors, andsince packaging a blister pack in an overpack bin may be less spatiallyefficient, the blister pack storage may allow more unit dose storage ofblister packs in a smaller footprint.

The unit storage device of FIG. 22 further includes user interface 966which may be used by authorized medical personnel to verify inventory,place medication orders, review medication order histories, etc. Theuser interface may allow orders to be placed for distribution to otherlocations, and may provide alerts and messages as will be describedfurther below.

The illustrated embodiment of FIG. 22 may further include storage ofas-needed medication. Such storage may be in the form of magazines(e.g., as shown in FIG. 9 ) or as-needed medication may be stored incompartments in the overpack bins. For example, aspirin may not be amedication that is specified on a medication order, but may beadministered to patients on an as-needed basis. As such, one or morecompartments of blister pack storage may be configured to holdunit-doses of aspirin. Such as-needed medication may be dispensed onrequest, with or without other medication orders.

While the unit storage devices illustrated in FIGS. 19-22 are configuredto hold trays of overpacks or carriers, other example embodiments ofunit storage devices are provided herein. For example, in an embodimentin which the input organization comprises a rod, as illustrated in FIG.8 , the unit storage device may include a peg-board style receiving areain which rods may be inserted for storage within the unit storagedevice. Unit storage devices according to further example embodimentsmay also be configured to use carousels which may include shelves, rods,or other storage means to accommodate the overpacks provided. Unitstorage devices according to embodiments of the present invention mayfurther be configured to receive overpacks without trays or carriers.For example, overpacks may be loaded onto shelves of a unit storagedevice as detailed further below.

Unit Storage Loading/Unloading

Unit storage devices according to example embodiments of the presentinvention may be configured to retrieve requested medicationsautomatically in response to a request. For example once a unit storagedevice is loaded with the medications which are needed, or predicted tobe needed on a unit during a period of time, the medications may berequested, or delivered in anticipation of a request, to a nurse serveror patient server. In some embodiments, the unit storage device may beconfigured to dispense medications and supplies directly to authorizedhealthcare personnel at the unit storage device.

Embodiments of the present invention may include a means for retrievingrequested medications in response to a request and means for loadingmedications onto or into a transport device. Embodiments of the presentinvention may provide a retrieving device for retrieving the requestedmedication or supply overpack from the unit storage device and a loadingdevice to load the retrieved medication onto a transport deviceconfigured to transport the requested medication or supply to the nurseserver or patient server. The retrieval device may be embodied in anumber of different forms. FIG. 23 illustrates an example embodiment ofa unit storage device 300 containing overpacks 302 of medication and/orsupplies. The overpacks 302 of the illustrated embodiment are variablewidth bins; however, overpacks of many forms may be implemented withembodiments of the unit storage device and retrieval device describedherein. The overpacks 302 are situated on shelves 304 within the unitstorage device 300.

Additionally, while the illustrated embodiment of FIG. 23 illustrates asingle layer of overpacks available for retrieval, further embodimentsmay include multiple layers of overpacks such that overpacks may bebehind the first layer, requiring overpacks on the first layer to bemoved to access the second layer, as shown in FIG. 22 . In still otherembodiments, the unit storage device may be two sided, such that twolayers of overpacks are directly accessible to be retrieved by virtue ofbeing arranged on both sides of the retrieval device.

The overpacks 302 of the illustrated embodiment of FIG. 23 may includeidentifying indicia disposed on the exposed, front side, such asbarcodes, text, etc. The overpacks 302 may optionally include RFID tagsfor identification. The unit storage device 300 may determine theoverpacks 302 stored therein by reading the RFID tags of the overpacksor by reading other identifying indicia of the overpacks when theoverpacks are initially loaded into the unit storage device. As shown,the overpacks 302 may be arranged on a substantially vertical planewhereby each of the overpacks 302 is individually accessible andretrievable without requiring removal or movement of other overpacks.

The retrieval device of the illustrated embodiment includes an X-Y robot310 configured to traverse the substantially vertical plane on which theoverpacks 302 are arranged. The X-Y robot 310 of the retrieval devicemay include a retrieval unit 306 disposed on an X-axis arm 312. Theretrieval unit 306 may be configured to move laterally along the X-axisarm 312 to access the width of the unit storage device 300. Theretrieval unit may be configured with a drive mechanism to advancelaterally along the X-axis arm. For example, the retrieval unit mayinclude a pinion gear that is rotated by an electric motor, where thepinion gear of the retrieval unit 306 engages a rack gear disposed alongthe length of the X-axis arm. A rack-and-pinion gear arrangement wouldafford the retrieval unit 306 precise indexing capabilities desirablefor repeatably retrieving overpacks accurately. Alternatively, theX-axis arm may include a belt or chain-drive mechanism which advancesthe retrieval unit 306 along the X-axis arm as a carriage. Such anembodiment may move the drive mechanism from the retrieval unit to amechanism located on the X-axis arm, providing a smaller, potentiallymore nimble retrieval unit.

The X-axis arm may be movable along the Y-axis along a pair of verticalcolumns 308. While the illustrated embodiment includes a pair ofvertical columns 308, embodiments may implement a single verticalcolumn. Further, the vertical columns 308 illustrated are disposed atthe distal edges of the unit storage device 300; however, the verticalcolumns 308 could be disposed anywhere along the width of the unitstorage device. The X-axis arm may be configured to move verticallyalong the columns 308 by one or more pinion gears disposed on the X-axisarm, engaging one or more rack gears disposed on one or more of thecolumns 308. Optionally, the X-axis arm may be advanced along thecolumns 308 by a chain or belt drive disposed in or on the columns 308moving the X-axis arm as a carriage.

While the above described and illustrated embodiment of an X-Y robotretrieval device includes stationary columns 308 and a movable X-axisarm, example embodiments may include a movable Y-axis arm and one ormore stationary X-axis arms arranged at the top and/or bottom of theunit storage device.

The retrieval unit 306 may be configured with a scanning deviceconfigured to scan identifying indicia of the overpacks 302. Thescanning device may include a barcode scanner, an image detectiondevice, or an RFID tag reader, for example. The retrieval unit 306 maybe configured to identify the overpacks and their locations within theunit storage device upon loading of the overpacks into the unit storagedevice. For example, when a tray of overpacks is loaded into a shelf ofthe unit storage device, in response to the unit storage device beingclosed (i.e., a loading door being shut), or in response to a usercommand, the retrieval device may advance along the shelves of thejust-loaded overpacks and scan each of the overpacks for identifyingindicia. Upon identifying an overpack, the retrieval device may storethe location and contents of the overpack.

The X-Y robot 310 and retrieval device 306 may also be configured toorganize or arrange overpacks within the unit storage device. Forexample, upon loading of the unit storage device, software may determinea more appropriate layout for the overpacks contained within the unitstorage device. Some medications may require refrigeration, in whichcase those overpacks may be moved to a refrigerated section. Further,overpacks may be grouped according to a time frame in which themedications contained therein may be needed. As such, the X-Y robot 310may optimize the layout of the overpacks to increase the efficiency ofretrieval and distribution of the medications.

In response to receiving an indication of the need of a particularmedication, or all of the medications for a particular patient or groupof patients, the retrieval device may commence the retrieval process inwhich the required medications are retrieved. The retrieval device mayadvance along the X and Y-axes of the unit storage device to thelocation of the first overpack to be retrieved. Upon arrival at thelocation of the first overpack to be retrieved, the retrieval unit 306may scan the identifying indicia of the overpack to confirm it is thecorrect overpack intended to be retrieved. In response to a positiveconfirmation, the retrieval unit may retrieve the overpack from thelocation. The retrieval may be in the form of pulling the overpack fromthe shelf and sliding the overpack onto a holding surface of theretrieval unit 306. Optionally, the retrieval unit may be configuredwith a grasping device configured to grab and hold the overpack toadvance the overpack to the transport device, described further below.

In response to retrieving the first overpack to be retrieved, theretrieval unit 306 may be advanced by the X-Y robot to a location withinor adjacent to the unit storage device for loading onto a transportdevice 320. Optionally, the retrieval unit 306 may position theretrieved overpack in a staged position ready to be placed onto atransport device as illustrated at 322. In the example embodiment ofFIG. 23 , the transport device 320 may be located above the unit storagedevice 300, configured to advance along a channel proximate the ceilingas will be described further below.

In some example embodiments, the retrieval device may retrieve theoverpack and place the overpack in a staged position awaiting thetransport device. In such an embodiment, a loading device may beconfigured to load the overpacks onto the transport device. The loadingdevice may be as simple as a mechanism by which overpacks are pushed orpulled onto the transport device. Additionally or alternatively, thetransport device may include the loading device, whereby the transportdevice is configured to load the overpacks onto the transport device.The retrieval device may also operate as the loading device, configuredto retrieve the overpacks and load them directly onto the transportdevice.

While the illustrated unit storage device is configured to temporarilystore overpacks of medications and supplies awaiting delivery to alocation proximate a patient, embodiments of the unit storage may alsoinclude devices arranged to load transport devices with overpacks upontheir arrival at the unit storage. For example, as illustrated in FIG.24 , the unit storage device 330 may be implemented as a loading deviceto load a transport device. The illustrated embodiment includes a unitstorage device 330 including a conveyor system 332 configured to receivea carrier 334 holding a plurality of overpacks 336. Once the carrier 334is loaded into the conveyor system 332, the conveyor advances thecarriers 334 toward a shuttle 338. The shuttle 338 is configured toadvance the carriers along a path defined by a track along which theshuttle 338 rides. The track may be disposed within an area proximatethe ceiling of a healthcare facility unit and may be enclosed asillustrated at 340.

FIG. 25 illustrates another view of the example embodiment of thehigh-capacity unit storage device with one of the banks 962 omitted forease of understanding. In the illustrated embodiment, an end-of-arm-tool(EOAT) is configured to be attached to a mechanism, such as a robot armor an X-Y robot, and moved into alignment with any of the compartments964 of the banks 962. The mechanism for moving the EOAT betweencompartments is not shown in the illustrated embodiment. The EOAT of theillustrated embodiment is configured to be a retrieval device arrangedto withdraw overpacks 972 from their respective compartment 974. Asshown, the EOAT has retrieved four medium sized overpacks 972 fromcompartment 974.

In practice, a request for medication and/or supplies may be received atthe unit storage device 960. The request may be received automaticallyfrom a network entity configured to request medications in anticipationof their need. Requests may also be received from the user interface 966of the unit storage device 960, a nurse server, patient server, nursecart, workstation, or mobile device. Upon receipt of the request, theunit storage device may be configured to fill the medication order byretrieving each of the medications and supplies that are requested. TheEOAT may be moved into alignment with a compartment 964, 974 containingone or more of the requested medications or supplies. The EOAT mayretrieve the overpacks 972 of the compartment, which may includeoverpacks that do not contain medication or supplies that are part ofthe order. The EOAT 970 may move the retrieved overpacks 972 to adispensing area 976 of the unit storage device 960. The dispensing area976 may include a mechanism for removing the overpacks 972 containingmedications or supplies that are part of the order from the EOAT 970.Overpacks 972 containing medications or supplies that are not part ofthe order may remain on the EOAT 970. The EOAT 970 may then return theoverpacks 972 not needed, and retrieve any additional overpacks from anyadditional compartments which may contain medication or supplies thatare part of the medication order. The additional overpacks may begrouped with the previously retrieved overpacks until all of theoverpacks containing medication or supplies in the request areretrieved.

The overpacks containing the medication or supplies in the request aregrouped and may be transported to a nurse server or patient server by atransport device as described further below, or dispensed from the unitstorage device to an authorized medical person. While the abovedescribed embodiment includes grouping the overpacks, in another exampleembodiment, the overpacks containing the medication and/or supplies maybe emptied at the dispensing area 976 to a patient-specific container978. The emptied overpacks may then be returned to their compartmentwith any unused overpacks, or alternatively, returned to anempty-overpack return area for subsequent return to the centralpharmacy. The patient specific container 976 may be transported to anurse server or patient server, or optionally, dispensed from the unitstorage device to an authorized medical person.

FIG. 26 illustrates another example embodiment of a unit storage device600 which is configured to load a transport device 606 with overpacksfor transport to a location closer to the patient for whom themedication or supplies are intended. The unit storage device 600 of FIG.26 may not be configured for static storage of overpacks, but insteadreceives a plurality of overpacks and queues them for transport to anurse server or patient server. In the illustrated embodiment, aserpentine conveyor 602 advances overpacks received at the unit storagedevice 600 to a staging area 604 where the overpacks await a transportdevice 606 to transport the overpacks to the appropriate nurse server orpatient server. Embodiments according to the illustration of FIG. 26 maybe configured to be very narrow and thus may be used in facilities inwhich floor space is limited. The embodiment of FIG. 26 may protrudeonly minimally from the wall to allow installation in hallways orquarters where minimal space is available.

Overpacks may be loaded into the unit storage device 600 groupedaccording to their destination such that they may be loaded ontotransport devices in groups. Optionally, in embodiments in which theoverpacks are not grouped according to destination, a scanner within theunit storage device 600 may scan identifying indicia of the overpack todetermine destination, and subsequently load each overpack onto atransport device destined for that destination. The unit storage devicemay assign a destination to a transport device once enough overpacks tofill the transport device have been scanned. Alternatively, if there arenot enough overpacks to fill a transport device and the time waiting forenough overpacks has exceeded a predefined threshold, the overpacks maybe loaded to a transport device and sent to their destination withoutthe transport device being full.

FIG. 27 illustrates another example embodiment of a unit storage device610 which may be transportable from the central pharmacy to the unit ofthe healthcare facility. In the illustrated embodiment, a cart includinga carousel that rotates as shown by arrows 620 may include a pluralityof bins 614 or locations where overpacks may be loaded at the centralpharmacy. The unit storage device 610 may be mobile such that uponloading at the central pharmacy, the device 610 may be transported(e.g., manually or via AGV) to a unit of the healthcare facility. A unitstorage device receiver 622 may be located on the unit configured toreceive the unit storage device 610 therein. The unit storage receiver622 may include a door or may be substantially closed off in response toreceiving the unit storage device 610. The unit storage receiver mayalso include spindles 618 configured to be received within bores 616 ofthe unit storage device. The spindles 618 may rotate within the bores616 to turn the carousel. The carousel may be rotated to provide accessto each of the overpacks stored therein. An automated retrieval device,such as the X-Y robot described above, or potentially a single-axisrobot, may retrieve the overpacks from the carousel and load them onto atransport device for transport to a location proximate the patient towhom the medication or supplies are to be administered.

While the illustrated embodiment depicts a mobile unit storage device610 including a carousel, embodiments may include only a cart with theoverpacks stored thereon, where the cart may be received at a unitstorage receiver and a retrieval device may retrieve the overpacks fromthe unit storage device as needed. Further, while the embodiment of FIG.27 relies on the rotating mechanics of the spindles 618 to be disposedin the unit storage receiver 622, further embodiments may include amotive mechanism within the unit storage device 610. The unit storagereceiver 622 may provide power, such as an electrical connection, topower the motive mechanism of such a unit storage device.

Further example embodiments of unit storage devices may include dynamicshelves (i.e., movable shelves) that may be loaded as outlined abovewith respect to static shelves. While an X-Y robot may be employed toload/unload static shelves in a unit storage device as outlined below,dynamic shelves, such as a carousel with a vertical axis of rotation,may allow a robot configured only to move in a Y-axis to access all ofthe shelf locations of the unit storage device as the carousel rotates.

Unit storage devices according to example embodiments of the presentinvention may also be configured to present overpacks directly to anauthorized medical person in response to receiving a request. Forexample, a nurse may be aware of an immediate need for a medication fora patient and may be near the unit storage device. The nurse may requestthe medication via user interface or via a remote device (e.g., a mobiledevice or nurse cart). The unit storage device may be configured topresent the requested medication to the nurse in response to receivingthe request.

Transport to Proximate Storage

As outlined above with regard to the carrier including a plurality ofbag-type overpacks, a shuttle may be configured to advance the carrierto a second location, which may include a nurse server or a patientserver as will be detailed further below. The shuttle 338 of FIG. 25 maybe configured to advance along a track to the nurse server or patientserver, each of which will be detailed further below.

Embodiments of the present invention provide various means fortransporting medications and overpacks from unit storage to a locationproximate a patient, such as a nurse server or patient server.Embodiments may further include means for transporting medications andoverpacks from the central pharmacy to a location proximate the patient.Such transport means as described herein may provide a substantiallyautomated mechanism for moving medications and overpacks throughout ahealthcare facility.

FIG. 28 illustrates an example embodiment of the carrier 334 of FIG. 25illustrated with a plurality of receivers 342, each configured toreceive a clip (not shown). In some embodiments, the clips may beintegrally formed with the carrier and not be removable. In otherembodiments, such as the illustrated embodiment, the clips may beremovable from the receivers 342 of the carrier 334.

The illustrated embodiment of the shuttle 338 includes a trapezoidalshaped projection 346 configured to be received within the trapezoidalrecess 344 of the carrier 334, similar to a dove-tail joint. In thisregard, the carrier 334 may be received on the shuttle 338 by alaterally sliding movement. The carrier 334 may be locked or latchedonto the shuttle 338; however, a lock or latch may be unnecessary if therate of movement of the shuttle and the lateral movement of the shuttleis below a degree in which the carrier would slide on the shuttle. Whenthe shuttle 338 moves along the track in the direction of arrow 348, oropposite arrow 348, the carrier is precluded from movement relative tothe shuttle in the direction of arrow 348 or opposite arrow 348 by theshape of the joint formed by the projection 346 and recess 344.

The shuttle 338 may be configured to be advanced along a track 350 by avariety of mechanisms. For example, as shown in the illustratedembodiment, the shuttle 338 may include rollers 352 attached to aportion of the shuttle 338, and the rollers 352 may be configured toride along a track 350. The shuttle 338 may be suspended from the track350 and advanced by the rollers 352 along the track. The rollers 352 maybe driven by, for example, an electric motor, which may receive powerfrom a battery pack, or alternatively from one or more bus barsextending along the track 350. Alternatively, the shuttle 338 may beadvanced along the track 350 by a cable or belt arranged proximate orinside of the track configured to pull the shuttle 338 along the track350. In some embodiments, the shuttle may be configured to advance alongthe track 350 using magnetic levitation or mag-lev. As will beappreciated, a variety of mechanisms may be employed to advance theshuttle 338 along the track 350.

As shown in FIG. 25 , the track along which the shuttle 338 and carrier334 may ride may be enclosed by enclosure 340 to preclude unauthorizedaccess to the medications during transport and to prevent externalinterference with moving shuttles, carriers, and the overpacks carriedtherewith. Example embodiments of transport devices that use tracks mayenjoy advantages over conventional transport means as the tracks may bedisposed proximate a ceiling, out of the way of patients, nurses, andphysicians in a healthcare facility. As embodiments of the presentinvention may be implemented in existing facilities which were notoriginally designed to accommodate such transport devices, positioningthe track and enclosure 340 proximate a ceiling may enable a facility toimplement the transport device while not interfering with areas used bypeople, wheelchairs, and other portable medical equipment. While exampleembodiments may be implemented in existing facilities, exampleembodiments may also be accommodated in the designs of new structures,allowing the transport devices to travel above a ceiling or betweenfloors of a healthcare facility.

FIGS. 25 and 28 illustrate an example embodiment of a shuttle that isloaded with a carrier; however further example embodiments of thepresent invention may provide for alternative transport devices that maybe used to move medications from a unit storage device to a locationproximate a patient. For example, pneumatic tube systems may beimplemented as a transport device to advance medications as directed bya software system and/or a user interface.

In a pneumatic tube system of example embodiments, a pneumatic tubecarrier may be loaded, either automatically or manually, at a unitstorage device, and transported through a pneumatic tube network to thedestination proximate a patient. In some embodiments, the overpack forthe medication and/or supplies may be a pneumatic tube carrier, orconfigured to be received within a pneumatic tube carrier.

Another example embodiment of a transport device which may be used withexample embodiments of the present invention may include a train systemthat is configured to carry overpacks to a location proximate a patient.As described above with regard to the shuttle and carrier, a track-basedsystem may be implemented in which a vehicle is advanced along thetrack. The train may include a single car or multiple train carembodiment which carries overpacks to their destination.

Referring back to FIG. 23 , the retrieval device 306 of the X-Y robot ofthe illustrated embodiment may be configured to retrieve overpacks fromthe unit storage and transport them to either a transport device 320 ora staging area 322. The retrieval device may also be configured to loadthe retrieved overpacks onto the transport device 320, or alternatively,a separate loading device may be implemented to load the retrievedoverpacks onto the transport device 320. In the illustrated embodimentof FIG. 23 , a car may be configured to receive the overpacks from theretrieval device 306. A single car may be configured to hold a pluralityof overpacks, and additional cars may be coupled together for thetransport of a greater number of overpacks.

The retrieval device 306 of FIG. 23 may also be configured to unloadempty bins from the transport device 320. For example, after dispensingthe contents of a reusable overpack, such as a bin, the empty bin may bereturned to the unit storage 300, and the retrieval device 306 mayretrieve the empty bin and move it to an area from which empty bins maybe retrieved for return to the central pharmacy.

The car of example embodiments may be configured to propel itself alongthe track by an electric motor, for example. The car may include one ormore driven wheels which contact the rail, and either by frictionalengagement or by toothed engagement (such as a pinion gear of the trainengaged with a rack gear of the track), the driven wheel(s) may advancethe train along the track.

FIG. 29 illustrates an example embodiment of a car 400 according toexample embodiments of the present invention. In the depictedembodiment, a plurality of overpacks 402, in this case bins of a commonprofile but differing widths, are staged in a staging area proximate theunit storage device (e.g., staging area 322 of unit storage device 300of FIG. 23 ). The car may include a plurality of loading devices 408configured to draw the overpacks 402 onto the car. The loading devices408 may also be configured to unload the overpacks 402 from the car bypushing them off to a staging area, nurse server, or patient server. Theloading devices 408 of the illustrated embodiment may each be sizedaccording to the width of the smallest overpack 402 such that a singleloading device 408 may be used to load and/or unload one of the smallestoverpacks. Larger overpacks may use more than one loading device 408 forloading and unloading. For example, an overpack that is twice the widthof the smallest overpack may use two loading devices 408 for loading andunloading.

While the illustrated embodiment includes the loading devices 408 on thecar 400, further example embodiments may include one or more loadingdevices disposed at the location where a car is to be loaded orunloaded, thereby removing the loading devices and their relatedstructure from the mobile car 400.

The depicted embodiment of a car 400 further includes a scanner 404configured to scan the identifying indicia on the overpacks 402. Asoutlined above, the identifying indicia may include a barcode, RFID tag,text, or the like. As such, the scanner may include a barcode scanner,an RFID reader, an image capture device, etc. to scan the indicia toread the identifying information contained therein. The scanner 404 mayprovide an indication of the contents of the overpacks to softwarecontrolling the car 400 and the loading devices 408 such that theloading devices 408 load only the overpacks 402 that are to betransported on the car 400.

While the staged overpacks 402 are described above as being disposedproximate the unit storage device, in some example embodiments, asfurther outlined below with regard to the nurse server and patientserver, there may be staging areas proximate the patient.

In any of the above referenced track or tube based transport devices,sensors may be disposed along the length of the track to determine wherea car may be located. Sensors may be disposed at specific locationsproximate to the unit storage device and proximate to the cardestination to facilitate accurate positioning of the car at the unitstorage device and nurse server or patient server. Sensors may includeoptical sensors, proximity sensors, RFID sensors (which may alsodetermine the identity of the car), or contact sensors. Additionally oralternatively, sensors may be disposed on the car and they may beconfigured to detect specific markings or way points disposed along thetrack to determine their position.

Another example embodiment of a track-based transport system isillustrated in FIG. 30 which depicts a car 440 engaged with a track 442.The illustrated car 440 includes a payload platform 444, a first bogie446, and a second bogie 448. The car 440 further includes a reader 450configured to obtain location information by reading a locationidentifying tape 452 which extends along the length of the track 442.Bracket 454 is illustrated as an example embodiment of a support whichmay be used to support the track 442 in an elevated, suspended position.

The track 442 may be of a variety of profiles to accommodate various carand bogie designs. FIG. 31 illustrates the cross-section or profile of atrack according to an example embodiment of the present invention. Theillustrated embodiment includes substantially square profile withchamfered corners 462 creating surfaces, some or all of which may beengaged by rollers of the bogies as described further below.

According to some embodiments of the present invention, bus bars 460 maybe disposed along the length of the track in order to conductelectricity for providing power to a drive system for a car riding alongthe track, to provide power for any processing capabilities which may beimplemented on the car (e.g., positioning/locating, loading/unloading,reading overpack indicia, etc.). Bus bars 460 of example embodiments mayalso be configured to provide a communications channel to and from thecar or cars riding along the track. As the bus bars 460 necessarily areelectrically conductive, and as the track may be made of an electricallyconductive material (e.g., extruded aluminum), the bus bars 460 mayrequire electrical insulation from the track 442.

The track profile of the illustrated embodiment further includes achannel 456 in which one or more bus bar insulators 458 may be received.While the illustrated embodiment includes two bus bar insulators 458,embodiments may include one bus bar insulator, or more than two bus barinsulators dependent upon the number of bus bars and the number of busbars accommodated by each bus bar insulator 458. The bus bar insulators458 are configured to receive therein one or more bus bars 460 and aremade of a material that is a poor conductor of electricity, such as aplastic. In some embodiments, the bus bars 460 may be mechanically heldin place by the bus bar insulators (e.g., by frictional engagement or bysnapping the bus bars into place) or the bus bars 460 may be adhered tothe bus bar insulators by an adhesive or the bus bars 460 may be heatedand pressed into the insulators such that the insulator materialsoftens, conforms around the edges, and holds the bus bars in place. Thebus bar insulators 458 may be held in the channel 456 by a deformablesnap 461 received into a channel 462. The deformable snap may be that ofa Christmas-tree fastener or other push-in clips. The deformable snap460 may extend along the length of the bus bar insulator 458, or thedeformable snap 460 may be disposed at intervals along the length of thebus bar insulators, sufficient to secure the bus bars and bus barinsulators to the track.

The profile of the track 442 of FIG. 31 further illustrates a locationidentifying tape 452 which is received along the length of the track442. The location identifying tape may be continuous along the entirelength of the track, or may be disposed periodically along the track.Location identifying tape according to embodiments of the presentinvention may include demarcations along the length of the track. Suchdemarcations may be read by a reader (such as reader 450 of FIG. 30 ) toascertain the location of the car along the track. The demarcations maybe located proximate (i.e., at short intervals) to one another to affordgreater accuracy to location determination; however, embodiments of carsconfigured to engage the track may be configured to accurately discerndistance travelled such that the demarcations may serve to re-calibrateor verify the location of a car along the track. In such an embodiment,the demarcations may be disposed along the track at greater intervals.Additionally or alternatively, while the illustrated embodiment includesa location identifying tape along the length of the track, in someexample embodiments, the location identifying tape may be disposed alonga wall of the enclosure in which the track-based transport devicetravels, or a wall of the facility along which the track extends.

Example embodiments of a track profile may further include one or morealignment slots, such as dovetail slots 464 and 466. Such alignmentslots may be configured to receive alignment tabs, as detailed furtherbelow, and/or to receive locking or securing members configured tofacilitate locking or securing of track sections together. Track profileembodiments may further include one or more grooved channel, such asgrooved channel 468. The grooved channel 468 may include grooves thatare arranged to engage a particular size and thread-pitch of fastener,such as an M6, M8, M10, M12, 1/4-20, 1/4-28, 3/8-16, 3/8-20, or any suchthreaded fastener. The dovetail slots 464, 466, and/or the groovedchannel 468 may also be configured for use as mounting location formounting a bracket thereto. The bracket may be used to mount the trackto a wall or other surface to suspend the track as necessary for routingthrough a facility.

Track profiles according to example embodiments of the present inventionmay be configured to accommodate lateral bends (e.g., left and rightturns) such that a track may follow contours of a facility. Further,track profiles may also be configured to accommodate vertical bends(e.g., up-hill, down-hill) to accommodate changes in elevation which maybe necessary. The bends of the track may be accomplished in a number ofmanners. For example, in the case of an extruded aluminum track, thetrack may be mandrel bent to the degree necessary. Further, whilestraight track sections may be made of a first material (e.g. extrudedaluminum), bends may be made of a second material which may be moreflexible. For example, a bend may be made of a polymer such ashigh-density polyethylene (HDPE) which may not be suitable for long,straight runs between supports, but the HDPE sections may be well suitedfor lateral or vertical bends, where supports may be more closelyspaced. Track sections made of more flexible materials, such asplastics, may include a structural member inserted there through toprovide rigidity. For example, if a bend were to be made of HDPE, a rib,such as a steel rod or tube of the same radius and degree of bend may beinserted into a cavity in the track section, such as cavity 470 of FIG.31 . A flexible length of track may also be bent to the appropriate bendand injected with a material into cavity 470 which may cure to renderthe track section relatively rigid. Track sections made ofnon-conductive materials, such as plastics, may not require the bus barinsulators 458 and may have channels for the bus bars formed directlyonto the track section.

As outlined above, a track-based transport system may use a track thatis formed in sections. However, the sections of the track may requiresecure joints there between that align the track sections and maintainelectrical continuity of bus bars extending along the track. FIG. 32illustrates an example embodiment of a pair of end caps which may beused to join together sections of track securely while maintainingalignment and electrical continuity of the bus bars. The first end cap472 is configured to be attached to the end of a first section of track476 and the second end cap 474 is configured to be attached to the endof a second section of track 478. The first end cap 472 is a female endcap while the second end cap 474 is a male end cap. The first section oftrack 476 and the second section of track 478 each include channels 477,479 for bus bars. These channels may be disposed, for example, on busbar insulators 458 as illustrated in FIG. 31 . Each of the end caps 472,474 also include channels 473, 475 configured to receive the bus bars.As can be seen on the first end cap 472, the channels extend paralleland aligned with the channels 477 of the first section of track 476, andcontinue, at an angle substantially perpendicular to the length of thetrack section, around a face 488 of the first end cap 472. While notvisible in FIG. 32 , the channels 475 of the second end cap 474similarly extend across a face of the second end cap, substantiallyperpendicular to the length of the second track section 478. The endcaps 472, 474 may be made of a material, such as a plastic, such thatthe channels 473, 475 do not require separate bus bar insulators.Further, as described in detail below, end caps made from a plastic mayallow deformation of features that may engage the track sections toprovide a more secure engagement.

Each of the first end cap 472 and the second end cap 474 of theillustrated embodiment include a first tab 480 and a second tab 482configured to be received within the section of track to which they areengaged. The first tab 480 is configured as a dovetail to engage the topdovetail groove as illustrated in FIG. 31 as 464. The second tab 482 ofeach end cap is configured to be received in the grooved channel 468 ofthe track profile of FIG. 31 . In order to hold the end cap to the endof the track sections, the dovetail tab 480 may include deformableelements configured to be deformed as the dovetail tab 480 is insertedinto the dovetail groove 464. The second tab 482 may be configured to bewider than the narrowest portion of the grooved channel (i.e., betweenthe peaks between the grooves) and narrower than the widest portion ofthe grooved channel (i.e., between the bottoms of the grooves). In thismanner, the ridges between the grooves may “bite” into the second tab482 as it is inserted into the grooved channel 468.

The protrusion of the second, male end cap 474 may be configured to bereceived within the recess of the first, female end cap 472. The secondend cap may also include an alignment ridge 484 while the first end capmay include an alignment channel 486. As shown in FIG. 32 , the first,female end cap 472 may include channels 488 disposed across the face orwidth of the end cap 472 for receiving therein one or more bus bars.

FIG. 33 illustrates two perspective views of the female first end cap472 including the bus bar channels 473, the first tab 480, the secondtab 482, and the alignment channel 486. Also illustrated are thedeformable members 481 of the first tab 480, and the recess 490 thatreceives the second end cap 474. FIG. 34 illustrates two perspectiveviews of the male second end cap 474 including the bus bar channels 475,the first tab 480, the second tab 482, and the alignment ridge 484. Alsoillustrated are the deformable members 481 of the first tab 480, and theprotrusion 492 that is received within the recess 490 of the first endcap 472. As illustrated, the first end cap includes an alignment channelat both the top and bottom of the recess 490 while the second end capincludes an alignment ridge at both the top and bottom of the protrusion492.

FIGS. 35 and 36 illustrate how the first end cap 472 and the second endcap 474 cooperate to align the first track section 476 and the secondtrack section 478. The first end cap of FIGS. 35 and 36 is shown astransparent for illustration purposes. As shown in FIG. 35 , the firsttrack section 476 and the second track section 478 are misalignedlaterally with the alignment ridge 484 of the second end cap 474 alignedwith the alignment channel 486 of the first end cap. The alignment ridge484 is received within the alignment channel 486, and as the first tracksection 476 and the second track section 478 are brought into alignment(aligning their lengths to be substantially collinear) as shown in FIG.37 , the protrusion 492 of the second end cap 474 is received within therecess 490 of the first end cap 472. As the first end cap 472 and thesecond end cap 474 align the first rack section 476 with the secondtrack section 478, the bus bars extending across the face of the firstend cap 472 (within the recess 490) are brought into engagement with thebus bars extending across the face of the second end cap 474 (around theprotrusion 492). FIG. 37 illustrates a cross section of the first tracksection 476 and the second track section 478 joined together by thefirst end cap 472 and the second end cap 474, with the bus bars 494,496, engaged along their lengths that extend across a respective endcap. Also visible in the cross-section of FIG. 37 is a biasing ridge 498configured to bias the bus bars 496 of the second end cap 474 intoengagement with the bus bars 494 of the first end cap.

FIG. 38 illustrates an example embodiment of a mechanism for securingthe track sections together once aligned and engaged with the first endcap 472 and the second end cap 474. The second end cap and second tracksection are omitted from FIG. 38 for ease of illustration. As shown, thefirst track section 476 includes the bus bars 494 which extend aroundthe end cap 472, across the face of the end cap, substantially acrossthe width of the track profile. The mechanism for securing the tracksections together includes a dovetail insert 904, a plate 902, andthreaded fastener 906. A second threaded fastener is shown receivedwithin the grooved channel of the first track section 476. The dovetailinsert 904 is configured to be inserted into the lower dovetail groove(dovetail groove 466 of FIG. 31 ) of the first track section 476, priorto engagement with the second track section. The dovetail insert can beinserted before or after the first end cap 472 is engaged with the firsttrack section. The first end cap 472 is configured with a dovetailgroove that aligns with the lower dovetail groove 466 of the first tracksection.

When initially inserted, the dovetail insert is received fully withinthe first track section 476 and the first end cap 472, not extendingbeyond the first end cap. Alternatively, the dovetail insert 904 couldbe inserted into the second track section 478 and the second end cap474. After assembling the first track section 476 with the first end cap472 to the second track section 478 with the second end cap 474, thelower dovetail grooves of the first track section, the first end cap,the second track section, and the second end cap, are aligned. Thedovetail insert 904 may then be slid within the aligned dovetail groovesto extend from the first track section to the second track section. Theplate 902 may then be aligned with the dovetail insert 904 and threadedfasteners 906 may be inserted through the plate 902 and into threadedholes of dovetail insert 904. The threaded fasteners may then engage thethreaded holes of the dovetail insert and be tightened. The first tracksection and the second track section may then be secured by thetightened threaded fasteners 906. The dovetail insert resists lateralmovement between secured track sections, thereby precluding the firstend cap 472 and the second end cap 474 from disengaging from one anotherlaterally along the alignment ridge 484 and the alignment channel 486.

Referring back to FIG. 30 , example embodiments of track-based transportsystems may include a car 440 configured to advance along the track 442.FIG. 39 illustrates an example embodiment of a car 440 including apayload platform 444, a first bogie 446, and a second bogie 448. Inorder to turn lateral bends of a track 442 as shown, each of the firstbogie 446 and the second bogie 448 may be rotatably coupled to thepayload platform 444. In the illustrated embodiment, each bogie includesa tilt bracket 914, 916 that is rotatable relative to the payloadplatform about a rotation axis 910, 912. The axes about which the tiltbrackets 914, 916 rotate are orthogonal to a plane defined by thepayload platform 444. In this manner, the tilt brackets 914, 916 mayturn relative to the payload platform 444 as the car 440 advances alongthe track 442 around a bend.

FIG. 40 illustrates an example embodiment of a car 440 according to thepresent invention configured to traverse vertical bends to transitionfrom traveling on a flat section of track to traveling on an incline ordecline. As shown, the car 440 includes a payload platform, a firstbogie 446 and a second bogie 448. The first bogie is rotatably coupledto the payload platform 444 by tilt bracket 914 and the second bogie isrotatably coupled to the payload platform 444 by tilt bracket 916 asshown in FIG. 39 . The first bogie 446 is pivotably connected to thefirst tilt bracket 914 by pin 920 which defines a first pivot axis. Thesecond bogie is pivotably connected to the second tilt bracket 916 bypin 922 which defines a second pivot axis. The first pivot axis isperpendicular to the first rotation axis about which the first tiltbracket 914 rotates relative to the payload platform 444 (i.e., aboutrotation pin 910). The second pivot axis is perpendicular to the secondrotation axis about which the second tilt bracket 916 rotates relativeto the payload platform 444 (i.e., about rotation pin 912). The abilityof the bogies 446, 448 to pivot relative to the payload platform alongthe pivot axes enables the car 440 to transition between flat tracksections and inclines or declines.

While the example embodiment of FIG. 40 can transition to inclines anddeclines, the distance between the bogies, the degree to which thebogies pivot, the grip of the drive wheels on the track, the power ofthe drive motors, the weight of the car, and the weight of the payloadeach contribute to determine the degree of transition that can betraversed by the car. Each of these factors can be configured accordingto the track layout for a particular facility. Further, the tiltbrackets 914, 916 may be adjustable relative to the payload platform 444to adjust the distance between the tilt brackets.

FIG. 41 illustrates a view of the car of FIGS. 39 and 40 engaged with atrack section 442 as viewed through a cross-section of the track. Asshown, the car 440 includes the tilt bracket 914 and bogie 446 coupledtogether by pin 920. A second pin may couple the bogie 446 to the tiltbracket 914 on the opposite side of the track 442; however, that pin isnot visible in the illustrated view. The bogie 446 may include a firstpair of rollers 924, 926 with each roller configured to engage anopposing surface of the rail, such as the lower surfaces 462 of thechamfered corners illustrated in FIG. 31 . The bogie 446 may alsoinclude a second pair of rollers 930, 932 with each roller configured toengage an opposing surface of the rail, such as the upper surfaces 462of the chamfered corners of FIG. 31 . As shown, each of the rollers isseparated from an adjacent roller, at least in part, by the track. Theaxis of rotation of each of the rollers is configured to besubstantially orthogonal to the plane defined by the payload platform444 when the car 440 is on a flat track surface. Each of the rollersincludes a roller surface that is disposed at an angle relative to theaxis of rotation of the roller, where the angle is between about thirtydegrees and about sixty degrees.

According to some embodiments, one or more of the rollers may beconfigured to be a driven roller. In the illustrated embodiment, oneroller 930 of the bogie 446 is configured to be driven. The drivenroller 930 of the illustrated embodiment is driven by an electric motor934 with a belt drive 936 arranged between the motor 934 and the drivenroller 930. In the illustrated embodiment, the motor has an axis ofrotation that is parallel to that of the driven roller 930 and theother, idler rollers 924, 926, and 932. While some example embodimentsof a car 440 may include a power source such as a battery to drive themotor, the illustrated embodiment taps electrical current from the busbars of the track. FIG. 41 depicts a series of rollers 928 configured tobe electrically coupled to the bus bars. Each bus bar is contacted byone or more conductive rollers, and the conductive rollers are engagedby a brush or contact to create an electrical connection between the busbars and the car 440. The car may use one or more of the bus bars toprovide current to the electric motor 934 and drive the car 440 alongthe track 442.

FIG. 42 illustrates the bogie 446 of FIG. 41 as viewed from the oppositeside, with the track removed. As shown, the bogie 446 includes roller924, 926, 930, and 932. The bogie may also include another pair ofrollers 938, 940, which may provide additional stability to the bogierelative to the track. Each of rollers 938 and 940 may also engage thelower surfaces 462 of the track. The rollers configured to engage thelower surfaces 462 of the track may ride on carriages 942, 944configured to move laterally away from the track, along arrows 952, 954.Moving the rollers 924, 926, 938, and 940 away from the track enable thebogie 446, and thus the car to be lifted off of the track. In theillustrated embodiment, the carriages 942 and 944 may include biasingelements, such as springs 950 configured to bias the carriages 942 and944 toward the track, and thus drive the rollers 924, 926, 938, and 940into engagement with the lower surfaces 462 of the track, in an engagedposition. Lock pins 946 and 948 may be used to retain the carriages 942,944 and the associated rollers in a loading position, wherein the bogiemay be free to be loaded and unloaded from the track.

While the aforementioned transport devices include track-based transportsystems, further transport devices may also be used to transportoverpacks to locations proximate a patient. For example, anotherembodiment of a transport device may include a continuous conveyormechanism to which carriers or train cars are coupled when they areready for transport, and the carriers or train cars may be de-coupledfrom the conveyor mechanism when they reach their destination along thepath of the continuous conveyor. A conveyor may be configured tocontinuously move along a transport path of a unit of a healthcarefacility (e.g., in an overhead transport enclosure) and overpacks may bearranged to be loaded and unloaded from the conveyor by a loadingdevice. For example, an overpack that is to be transported from a unitstorage facility to a location proximate a patient may be pushed onto amoving conveyor. The conveyor may advance along its path toward thelocation proximate the patient. A scanner at the location proximate thepatient may scan the identifying indicia of the overpack and recognizethe overpack as being destined for the location proximate the patient. Aloading device at the location proximate the patient may unload theoverpack from the conveyor, either to a staging area proximate thepatient or to a patient or nurse server. Similarly, the loading deviceat the location proximate the patient may load an empty overpack to theconveyor for return to the unit storage device or to a locationspecifically configured for the return of empty or unneeded overpacks.

While above example embodiments of transport devices may can beimplemented in existing facilities by mounting a track and enclosure 340proximate a ceiling, other transport devices may not require a track orenclosure to transport medication to a location proximate a patient. Forexample, an automated guided vehicle may transport medications andsupplies from a unit storage device to a location proximate a patientwhile traveling along hallways shared with patients, nurses, andphysicians. An automated guided vehicle, or AGV, may arrive at a unitstorage device and may be loaded either manually or automatically withmedications and supplies. The AGV may then transport the medications andsupplies to the location proximate the patient, by guiding themselvesalong the hallways of the healthcare facility. The AGVs may beconfigured to advance along conductive tracks embedded into the floors,or the AGVs may be programmed with facility layouts to guide themselvesthrough hallways. In either embodiment, the AGVs may be capable ofdetecting obstacles and people to slow down or stop to avoid contactingan obstacle or person. The detection capabilities may be in the form ofproximity sensors, optical sensors, contact sensors, etc. The AGVs ofexample embodiments may be powered by batteries which may berechargeable.

The aforementioned transport devices may be configured to transportmedication and supplies from a unit storage device to a location closerto a patient, which may be in the form of a staging area proximate apatient, a nurse server, or a patient server, embodiments of which aredescribed herein below. While the aforementioned transport devices maybe described with respect to transporting medication from the unitstorage device to a location closer to a patient, embodiments mayinclude transport devices configured to transport medications directlyfrom the central pharmacy to a location proximate a patient. Such anembodiment may be implemented where the central pharmacy includesvarious features described above with respect to the unit storagedevice. For example, a central pharmacy may include a pneumatic tubesystem or track-based transport system which may be loaded and sentdirectly to a location proximate the patient.

Proximate Storage

Embodiments of the present invention as described above may beconfigured to transport medication and supplies from a unit storagedevice, via a transport device, to a location proximate a patient.Embodiments of the present invention may provide means for staging andor storing medication at a location proximate a patient. The locationproximate to a patient may include a location that is disposed betweenthe unit storage device and the patient bed. Example embodiments of thelocation proximate the patient may be referred to herein as proximatestorage, including a staging area proximate the patient, a nurse server,and a patient server.

Proximate storage embodiments including a staging area may be used inconjunction with a nurse server or patient server. The staging area maybe configured to receive medication and supplies, such as in theoverpacks described above, and temporarily store the overpacks whileawaiting dispensing to authorized medical personnel. As illustrated inFIG. 29 , the staging area may be arranged adjacent to the track of atrack-based transport device such that the transport device maytransport the overpacks from the unit storage device to the staging areaproximate the patient and leave the overpacks at the staging area whilethe transport device delivers additional overpacks to additional stagingareas. The staging area used for proximate storage may allow a transportdevice to continue to transport overpacks, thereby improving theefficiency with which the transport device is operating. Further,staging proximate a nurse server or patient server may reduce deliverytime of medications.

As outlined above, the track-based transport device may be configured totravel along a track that is enclosed (e.g., enclosure 340 of FIG. 25 )proximate a ceiling of a unit of a healthcare facility. The track mayalso be disposed in an area above the ceiling, or below the floor of aunit of a healthcare facility. As such, a staging area may similarly bedisposed in an enclosure proximate a ceiling, in an area above aceiling, or in an area below the floor in dependence upon the locationof the track-based transport device. The staging areas may be arrangedat locations proximate to patients and proximate to a nurse server orpatient server.

An example embodiment described above with respect to FIG. 29 includedloading and unloading overpacks from a train car 400, some embodimentsof track-based transport devices may use the transport device forstoring or staging the overpacks proximate to the patient. FIG. 43illustrates an example embodiment of a track-based transport systemwhich includes a main track 420 and loops 426 extending from the maintrack. In the illustrated embodiment, each of the track loops 426 extendproximate a patient server or nurse server 424. A transport device, suchas a train car 422, may be advanced from a unit storage device bound fora patient server 424. Upon arrival at the track loop 426 proximate theappropriate patient server, the train car may be diverted to the trackloop of that patient server. The train car may be diverted by aconventional switch 432 used in track-based or rail-based transportdevices. The diversion of the train car may be controlled, for example,by logistics software that tracks and directs transport devices to theirappropriate locations. Additionally or alternatively, the car may beprogrammed to be autonomous with destination information. In such anembodiment, the car may be configured to control track switches asneeded, or to select a track path without the use of switches.

FIG. 43 illustrates a train car 428 staged at a patient sever 424 readyto dispense the contents of the overpacks on the train car 428 to thepatient server. Since the track loop 426 is arranged off of the maintrack 420, train car 422 may travel along the main track 420uninterrupted to its destination. While the illustrated embodimentdepicts track loops 426, embodiments may also include track spurs 430.The track spurs 430 may require fewer switches 432; however, the trackspurs 430 also require the train cars to be reversed to enter back ontothe main track 420. Track loops 426 also may offer additional stagingspace for multiple train cars 428.

Nurse Servers and Patient Servers

While staging of overpacks may be performed track-side or along thetrack with a track-based transport device, staging may also be performedat or in nurse servers or patient servers. A nurse server is a deviceconfigured to be accessed by a nurse (or other authorized medicalpersonnel) for the retrieval of medication and supplies for a pluralityof patients served by that nurse. A patient server is a deviceconfigured to be accessed by a nurse (or other authorized medicalpersonnel) for the retrieval of medication and supplies for a singlepatient.

While the term nurse server implies access by a nurse, any authorizedmedical person may access the nurse server. For example, a doctor, alaboratory technician, anesthesiologist, a phlebologist, or aphlebotomist may be considered an authorized medical person which may beauthorized to access one or more nurse servers as will be describedfurther below.

The number of patients served by a nurse server may vary, and may be allof the patients for whom a nurse has responsibility or for a subset ofthe patients for whom a nurse has responsibility. As the nurse server isconfigured to provide medication and supplies for a plurality ofpatients, the nurse server may be located in an area close to thepatients served by the nurse server. This location may be closer to thepatients served than the unit storage device outlined above.

On the other hand, a patient server may be configured to serve only asingle patient. The patient server may be accessed by authorized medicalpersonnel as outlined above and described further below. As the patientserver serves only a single patient, the patient server may be locatedclose to that patient. A patient server may be located in the patient'sroom or nearby for convenient access by the authorized medicalpersonnel. Generally, a patient server is not intended to be accessed bya patient, but rather by the medical personnel caring for the patient.

While example embodiments of patient servers and nurse servers differ inthe number of patients they are configured to serve, their function maybe substantially similar. However, some features may be better suited toone or the other as will be appreciated by one of skill in the art.

As outlined above medication and supplies may be received at a nurseserver or patient server and staged to await dispensing to authorizedmedical personnel. Medication and supplies may also be received inresponse to a request such that they are dispensed upon arrival ratherthan staged. In still other embodiments, medication and supplies may bedelivered to the nurse server or patient server for just-in-time (JIT)dispensing to authorized medical personnel.

Medications and supplies may be dispensed from the nurse server orpatient server in a variety of manners. In one example embodiment, whenthe medication needed by a patient arrives at the nurse server, amessage may be sent to the appropriate authorized medical person that isresponsible for retrieving and administering the medication to thepatient. In such an embodiment, an overpack may arrive at the nurseserver or at a staging area proximate the nurse server, and uponscanning of the identifying indicia, an alert or message may be sent,for example via a wireless network or near-field communication protocol,to a device carried by the authorized medical person. The device mayinclude a pager, a phone, a tablet computer, or any other portabledevice able to receive and present the alert or message.

In another example embodiment, described with respect to the nurseserver 500 illustrated in FIG. 44 , an authorized healthcare person mayarrive at the nurse server, and using a user interface 502, which mayinclude a touch screen, keypad, display, etc., request medications andsupplies for a particular patient. The authorized medical personnel mayfirst be required to provide identification of themselves to confirmthat they are an authorized medical person, then the authorized personmay enter a patient's identification. After receiving the patient'sidentification, the medication and related supplies may be dispensed,for example, to dispensing area 504. In an embodiment in which theserver 500 is a patient server, the authorized medical person may onlyneed to identify themselves and ok the dispensing of medication, as thepatient server would not require the identification of the patient sinceit is configured to only dispense for a single patient.

In some example embodiments, the dispensing area 504 may include a bin506 which may then be taken by the authorized medical person to thepatient for administering the medication. The bin 506 may then bereturned to the nurse server 500. The medication and supplies may bedispensed to the dispensing area 504 from a staging area above the nurseserver 500 or they may be dispensed directly from a transport deviceabove the nurse server. The medications and supplies may be gravity fedfrom the staging area or the transport device to the dispensing area.

FIG. 45 illustrates another example embodiment of a nurse station 520which includes a user interface 522 and a medication dispensing drawer530. In the illustrated embodiment, a track based transport device, suchas the illustrated carrier 526, may arrive at the nurse server 520 or bestaged above the nurse server awaiting dispensing. In response to arequest, or ahead of an anticipated request, the carrier 526 may beadvanced down thru the nurse server to a dispensing area 524, whichincludes a viewing window in the illustrated embodiment. Afterauthorization of the authorized medical person, the medication andsupplies overpacks may be dispensed to the dispensing drawer 530. Theauthorized medical person may then remove the medications and suppliesfor administering to a patient. The embodiment of FIG. 45 may also beimplemented as a patient server configured to dispense medication onlyfor a single patient.

FIG. 46 illustrates another example embodiment of a nurse server 540according to an example embodiment of the present invention. Theillustrated embodiment depicts an enclosure 542 proximate the ceiling ofthe healthcare facility unit. The enclosure 542 may enclose a track fora track-based transport device to transport overpacks of medications andsupplies to the nurse server 540 ahead of or in response to requests formedication or supplies. The illustrated embodiment may be well suitedfor the overpacks of FIG. 5 . Upon receipt of the overpack boxes, an X-Yrobot within the nurse server, similar to the X-Y robot described withregard to the unit storage device above, may place the overpack boxes onshelves within the nurse server 540. The nurse server may include a userinterface 544 and a plurality of doors 546, and larger doors 548, eachconfigured to be individually openable.

In response to the authorization of an authorized medical person, and arequest for medication for a particular patient, the doors arranged infront of the overpack(s) containing the medication requested may beunlocked allowing the person to open the doors, or the doors may beconfigured to open automatically. The authorized medical person may thenaccess the contents of the overpack. FIG. 47 illustrates an exampleembodiment of how a nurse server according to FIG. 46 may operate. Inthe illustrated embodiment, an overpack containing the requestedmedication is advanced from the plurality of overpacks available 552 tothe plurality of doors 554. In response to the overpack 550 being placedat a subset of the plurality of doors (namely doors 556), the doorsbecome unlocked or unlatched. The doors may then be opened asillustrated to access the contents of the overpack 550. Doors that arenot arranged in front of the selected overpack 550 may remain locked,precluding access to the plurality of overpacks 552 other than theselected overpack 550. The selected overpack 550 may be advanced, forexample, by the X-Y robot or by actuators disposed in the nurse serverarranged to present selected overpacks to an authorized person.

Referring back to FIG. 46 , the nurse server 540 may include largerdoors 548 arranged to provide access to larger overpacks, oralternatively, the large doors 548 may provide access to manually loadedbins containing medications and supplies not provided to the nurseserver by the automated transport device. Medications such as as-neededmedications or supplies that may be used on an as-needed basis may notbe predicted by a system of example embodiments such that a supply ofas-needed supplies and medications may be maintained at a nurse serveror patient server.

FIG. 48 provides another example embodiment of a nurse server 560according to the present invention. The illustrated nurse server 560 maybe a fully integrated nurse server that is recessed into a wall of ahealthcare facility; however, embodiments may also include unitsextending from the wall in facilities where the wall does not providesufficient room, or in embodiments where the nurse server and transportdevices are added after construction of the facility. The depictedembodiment includes a user interface 562 and a plurality of drawers 564.The drawers may be patient specific such that all of the medication andsupplies needed by a patient may be contained within a single drawer564. In the case of a patient server, each of the drawers 564 may betime-specific for the patient served by the patient server, such thatone drawer may contain medications needed for the morning, one formid-day, and one for evening.

While the drawers 564 of the illustrated embodiment of FIG. 48 may bemanually loaded, example embodiments of the present invention mayprovide for automatic loading of the drawers 564 via a transport deviceas described above. A transport device may move medications and suppliesfrom a unit storage device to the nurse server 560 along, for example, atrack, and upon arrival at the nurse server, the overpacks carried bythe transport device may be moved to the appropriate drawer by a lift566 which may be integrated into a wall of the facility or alternativelyintegrated into a nurse server projecting from the wall.

Each of the example embodiments of nurse servers described above mayinclude an area configured to receive medications and supplies deliveredto the nurse server but not needed or empty, returnable overpacks. Thereturn area of the nurse server may be a drawer, bin, or other receivingarea which is arranged to receive articles for return to the unitstorage device or to the central pharmacy. The return area of someembodiments may stage overpacks for retrieval by a transport device forautomated return of the overpacks, or alternatively, returns may bemanually collected for return to the unit storage or the centralpharmacy.

FIG. 49 illustrates another example embodiment of a nurse serveraccording to embodiments of the present invention. In the illustratedembodiment, a user interface 570 is disposed on an articulated arm 576which may include spring or weight counter-balancing to enable the userinterface 570 to be easily positioned in a raised position as shown, orin a lowered position, accessible by authorized medical personnel. Anurse or other authorized medical person may arrive at the nursestation, pull the user interface 570 down to an accessible position, andupon authorization, provide a request for medication or supplies. Themedication or supplies may be staged nearby, such as in the overheadstorage 572 which may be track-side storage as outlined above. Inresponse to the authorized request, the medication or supplies may bedispensed to a retrieval area 574. The authorized medical person maythen retrieve the medication or supplies for administration to apatient. When the dispensing is complete, the user interface 570 may bemoved back to a raised position, out of the way. The example embodimentof FIG. 49 may be implemented in healthcare facilities where hallwaywidths do not allow for additional, permanent structures to project fromthe walls.

FIG. 50 illustrates another example embodiment of a nurse server whichmay include a user interface 582 and an openable access panel 580. Inresponse to an authorized medical person being identified at the userinterface, the access panel 580 may be unlocked or automatically openedto provide access to the contents therein. The panel 580 may provide awork surface 586 when in the open position. The authorized medicalperson may retrieve medications and supplies for a patient from aretrieval area 584 disposed behind the access panel 580. The medicationor supplies may be dispensed to the retrieval area by an automatedtransport device as described above. Unneeded medication or supplies, orreturnable/reusable overpacks may be deposited in the return slot 588for return to the unit storage device or to the central pharmacy.

FIG. 51 illustrates another example embodiment of a nurse server whichmay be embodied as a portable cart 596. The portable cart may beassigned to a nurse for use during their shift. Through a userinterface, such as a user interface 598 on the cart 596, a nurse orauthorized medical person may request medications and supplies for apatient or for a plurality of patients. The request may be transmitted,e.g. via a healthcare facility network, to a unit storage device. Theunit storage device may load the medication overpacks onto a transportdevice for transport to a location proximate to the requesting nurse.Upon arrival, the nurse may be signaled that the medication has arrived.The alert may be received, for example, at the user interface 598, orother device, such as a pager or portable communication device carriedby the nurse, or a healthcare facility unit dashboard (e.g., a screendisplaying information at a nurse station). The nurse may then go to theproximate storage location 592 where the medications are staged, whichmay be, for example, in an overhead enclosure where the transport devicemay be disposed. The nurse may provide identification at the proximatestorage location 592 through a user interface at the location, orthrough the user interface 598 of the cart 596, after which themedication overpacks 590 may be lowered to a location from which thenurse may retrieve them. The overpacks 590 may then be loaded into thecart for administration of their contents to the appropriate patient.The illustrated overpacks 590 may be patient specific or may be unitdose overpacks. In patient specific overpacks 590, the overpack 590 mayinclude all of the medications needed for a patient at a particulartime.

Nurse servers or patient servers according to the aforementionedembodiments may include a scanner configured to scan the medication orsupplies, and/or the overpacks containing the medication or supplies.The scanner may scan identifying indicia to confirm retrieval of thescanned objects from the nurse server or patient server. The scanningmay further provide an additional verification step that confirms thatthe appropriate medication or supply is being dispensed from the nurseserver or patient server.

Nurse servers or patient servers according to the aforementionedembodiments may further include a printer. While medications transportedto the nurse server or patient server may be designated for a particularpatient, the patient information may not be presented on the medication,particularly since the medication or supply may be returned to thecentral pharmacy if it is not needed by the patient, such as if thepatient is discharged before the medication is administered. As such, aprinter at the nurse server or patient server may be configured to printpatient information to a label to be affixed to the medication orsupply, thereby designating the patient for which it is intended. Theprinter may print patient information in response to a scan of themedication as described above, or it may print the labels in response tothe authorized medical person accessing the nurse server and retrievingthe medication or supply.

In some embodiments, nurse servers may include temperature controlledareas. For example, in the embodiment of FIG. 48 , one or more of thedrawers 564 may include a refrigerated compartment to maintainrefrigerated medications at the appropriate temperature until dispensed.In such an embodiment, a printer may be configured to print a label forthe medication upon dispensing which identifies the time at which it wasdispensed, which may correspond to the time the medication was removedfrom refrigerated storage. In such an example, the medication may have amaximum shelf-life outside of refrigerated storage after which themedication is no longer fit for administration to a patient. The timeafter which the medication must be disposed may be printed to the labelwhen the medication is dispensed from the nurse server. Optionally,“printing” may be performed by writing to an RFID tag or writing to anelectronic ink label.

As outlined above, some medication may require refrigeration to maintainits efficacy. Such medications may be given a maximum shelf-life outsideof refrigeration. The shelf-life of such a medication may be a timesince the medication was initially removed from refrigeration, or acumulative time of the medication outside of refrigeration. According toembodiments of the present invention, as transportation and storage ofmedications may be automated and controlled, the logistics software forrouting (i.e., mapping out a route for) and dispensing of medicationsmay be configured to monitor the time of a medication outside ofrefrigerated storage. For example, a medication may be outside ofrefrigerated storage between the central pharmacy and the unit storagedevice. At the unit storage device, the medication may be maintained ina refrigerated storage area. The medication may again be outside ofrefrigerated storage during transport to proximate storage near apatient. Upon arrival at the proximate storage, the medication may ormay not be stored in a temperature controlled location. As such, thesoftware may monitor the cumulative length of time the medication isoutside of refrigerated storage. If the medication is outside ofrefrigerated storage longer than the shelf-life outside of refrigeratedstorage, the medication may be automatically routed back to the unitstorage device and/or to the central pharmacy. If the medication hasshelf-life remaining at the time of dispensing, the time remaining maybe displayed to a nurse on a user interface of a nurse server or patientserver, or optionally printed to a label for the medication.

According to example embodiments of the invention, temperature sensitivemedications or supplies may be packaged in overpacks that includetemperature monitoring capabilities. The temperature monitoring may beperformed by a temperature monitoring strip which displays the time thatthe strip or the products attached thereto, have been exposed totemperatures exceeding a threshold. Temperature monitoring may also beperformed by an RFID tag configured to generate a temperature profilewhich may be analyzed when the information is read from the tag. Use oftemperature monitoring may allow inventory monitors or controls todetermine if a medication has exceeded a maximum temperature or exceededa maximum time above a threshold temperature, in which case themedication would be returned to a central pharmacy for disposition.

Overpacks may also be configured to maintain a temperature of amedication. For example, an overpack may be insulated and may contain acold-pack configured to keep the temperature inside the overpack below athreshold value. Overpacks may also include material, such as a phasechange material, configured to maintain overpack contents at or around adesired temperature. Such overpacks may be used to extend the shelf-lifeof a medication or to allow transportation of medications outside ofrefrigerated storage for a longer period of time.

As noted above, embodiments of the present invention may requireidentification of the authorized medical person before providing accessto the medication or supplies dispensed by the nurse server or patientserver. Identification of appropriate medical personnel may beaccomplished by the scanning of an identification card which may includea barcode or RFID tag. Alternatively, identification of authorizedmedical personnel may be accomplished by biometric scanning, such as ascan of a person's retina, finger print, hand geometry, palm vein, face,or voice to determine the identification of the person. Identificationmay also be provided by a personal identification number (PIN), or anycombination of the aforementioned mechanisms.

Appropriate identification of medical personnel may be important topreclude unauthorized access to medications and to satisfy regulatoryrequirements. Requiring medical personnel to properly identifythemselves may also preclude a nurse from accessing the wrong nurseserver by limiting the medical personnel authorized to access aparticular nurse server or patient server. Further, requiringidentification of medical personnel may provide an audit trail toidentify who retrieved medication for a particular patient.

Nurse servers or patient servers as described above may be configured toprovide an estimated time of arrival for medications or supplies at anurse server or patient server. For example, a nurse may enter a requestfor a medication or supply to be dispensed from a nurse or patientserver, and the user interface may provide an estimated time of arrivalfor the medication or supply at the nurse or patient server. Accordingto some embodiments, the medication or supply may be staged forimmediate dispensing; however, some medications or supplies may not bepresent at the patient server or nurse server. Providing an estimatedtime of arrival for the medication or supply may allow an authorizedmedical person to perform other tasks while awaiting delivery of themedication or supply. As embodiments described above may includesubstantial automation of the retrieval and delivery of medications andsupplies to locations proximate to a patient, logistic softwareconfigured to route the medication and supplies may be able to provide avery accurate estimated time of arrival of the requested medication orsupply at the nurse server or patient server.

As described above, the nurse server or patient server may be used tointerface with a network of a healthcare facility to ensure accuratedispensing of medications to authorized personnel. The automation andthe transfer of data and information may be implemented in variousembodiments of the present invention. As used herein, where a computingdevice is described herein to receive data from another computingdevice, such as receiving an indication of medication required, it willbe appreciated that the data may be received directly from the anothercomputing device and/or may be received indirectly via one or moreintermediary computing devices, such as, for example, one or moreservers, relays, routers, network access points, and/or the like.Similarly, where a computing device is described herein to send data toanother computing device, it will be appreciated that the data may besent directly to the another computing device or may be sent to theanother computing device via one or more interlinking computing devices,such as, for example, one or more servers, relays, routers, networkaccess points, and/or the like.

In some example embodiments, processes and steps of the invention may becarried out by computing devices that may be in communication with anetwork, such as an information network of a healthcare facility. Thecomputing devices may include nurse servers, patient servers, portablecommunications stations, or the like. Such a network may be embodied ina local area network, the Internet, any other form of a network, or inany combination thereof, including proprietary private and semi-privatenetworks and public networks. The network may comprise a wire-linenetwork, wireless network (e.g., a cellular network, wireless local areanetwork, wireless wide area network, some combination thereof, or thelike), or a combination thereof, and in some example embodimentscomprises at least a portion of the Internet.

In some example embodiments, computing devices configured to performvarious operations of the invention may include computing devices, suchas, by way of non-limiting example, a server, configured to access anetwork and/or server(s). In some example embodiments, computing devicesmay be implemented as a distributed system or a cloud based entity thatmay be implemented within a network. In this regard, a computing deviceaccording to the present invention may comprise one or more servers, aserver cluster, one or more network nodes, a cloud computinginfrastructure, some combination thereof, or the like. Additionally oralternatively, embodiments may be implemented as a web service.

Further example embodiments of the present invention may include asystem comprising any number of user terminals. A user terminal may beembodied as a laptop computer, tablet computer, mobile phone, desktopcomputer, workstation, nurse server, patient server, or other likecomputing device.

The computing device of example embodiments may include processingcircuitry. The processing circuitry may be configured to perform actionsin accordance with one or more example embodiments disclosed herein. Inthis regard, the processing circuitry may be configured to performand/or control performance of one or more functionalities of thehandling, transporting, storing, or distributing of medications and/orsupplies in accordance with various example embodiments. The processingcircuitry may be configured to perform data processing, applicationexecution, and/or other processing and management services according toone or more example embodiments. In some embodiments, computing deviceor a portion(s) or component(s) thereof, such as the processingcircuitry, may be embodied as or comprise a circuit chip. The circuitchip may constitute means for performing one or more operations forproviding the functionalities described herein.

A schematic illustration of an apparatus which may be implemented as anurse server, patient server, or user terminal in a central pharmacy orunit storage device is illustrated in FIG. 52 . As shown, in someexample embodiments, the processing circuitry may include a processor700 and, in some embodiments, may further include memory 710. Theprocessing circuitry may be in communication with, include or otherwisecontrol a user interface 720 and/or a communication interface 730. Assuch, the processing circuitry may be embodied as a circuit chip (e.g.,an integrated circuit chip) configured (e.g., with hardware, software,or a combination of hardware and software) to perform operationsdescribed herein.

The processor 700 may be embodied in a number of different ways. Forexample, the processor may be embodied as various processing means suchas one or more of a microprocessor or other processing element, acoprocessor, a controller, or various other computing or processingdevices including integrated circuits such as, for example, an ASIC(application specific integrated circuit), an FPGA (field programmablegate array), or the like. Although illustrated as a single processor, itwill be appreciated that the processor may comprise a plurality ofprocessors. The plurality of processors may be in operativecommunication with each other and may be collectively configured toperform one or more functionalities of a system for handling, storing,transporting, or distributing medication as described herein. Theplurality of processors may be embodied on a single computing device ordistributed across a plurality of computing devices. In some exampleembodiments, the processor may be configured to execute instructionsstored in the memory or otherwise accessible to the processor. As such,whether configured by hardware or by a combination of hardware andsoftware, the processor may represent an entity (e.g., physicallyembodied in circuitry—in the form of processing circuitry) capable ofperforming operations according to embodiments of the present inventionwhile configured accordingly. Thus, for example, when the processor isembodied as an ASIC, FPGA, or the like, the processor may bespecifically configured hardware for conducting the operations describedherein. Alternatively, as another example, when the processor isembodied as an executor of software instructions, the instructions mayspecifically configure the processor to perform one or more operationsdescribed herein.

In some example embodiments, the memory 710 may include one or morenon-transitory memory devices such as, for example, volatile and/ornon-volatile memory that may be either fixed or removable. In thisregard, the memory 710 may comprise a non-transitory computer-readablestorage medium. It will be appreciated that while the memory 710 isillustrated as a single memory, the memory may comprise a plurality ofmemories. The plurality of memories may be embodied on a singlecomputing device or may be distributed across a plurality of computing.The memory may be configured to store information, data, applications,instructions and/or the like for enabling embodiments of the presentinvention to carry out various functions in accordance with one or moreexample embodiments. For example, the memory may be configured to bufferinput data for processing by the processor. Additionally oralternatively, the memory may be configured to store instructions forexecution by the processor. As yet another alternative, the memory mayinclude one or more databases that may store a variety of files,contents, or data sets. Among the contents of the memory, applicationsmay be stored for execution by the processor to carry out thefunctionality associated with each respective application.

A user interface 720 of example embodiments, such as the user interfaceof a nurse server or patient sever, may be in communication with theprocessing circuitry to receive an indication of a user input at theuser interface and/or to provide an audible, visual, mechanical, orother output to the user. As such, the user interface may include, forexample, a user input interface 720 such as a keyboard, a mouse, ajoystick, a display, a touch screen display, a microphone, a speaker,and/or other input/output mechanisms. As such, the user interface may720, in some example embodiments, provide means for user control ofembodiments of the present invention. In some example embodiments inwhich the invention is embodied as a server, cloud computing system, orthe like, aspects of user interface may be limited or the user interfacemay not be present. In some example embodiments, one or more aspects ofthe user interface may be implemented on a user terminal. Accordingly,regardless of implementation, the user interface may provide input andoutput means to facilitate handling, storing, transporting, or deliveryof medication in accordance with one or more example embodiments.

The communication interface 730 may include one or more interfacemechanisms for enabling communication with other devices and/ornetworks. In some cases, the communication interface may be any meanssuch as a device or circuitry embodied in either hardware, or acombination of hardware and software that is configured to receiveand/or transmit data from/to a network and/or any other device or modulein communication with the processing circuitry. By way of example, thecommunication interface 730 may be configured to enable embodiments ofthe present invention to communicate with application server(s) and/ornetworks and/or information databases. Accordingly, the communicationinterface may, for example, include supporting hardware and/or softwarefor enabling communications via cable, digital subscriber line (DSL),universal serial bus (USB), Ethernet, or other methods.

A First Example Embodiment of a System

While various components of a system for automating the dispensing ofmedications and supplies to patients within a healthcare facility havebeen described above, an example embodiment using components of thesystem is described herein to further illustrate the functionality ofsuch a system.

The example embodiment system described herein is described with respectto a healthcare facility including multiple units, such as an intensivecare unit, a long-term care unit, a psychiatric unit, a maternity unit,etc. Embodiments may include a central pharmacy configured to dispensemedication to patients in each of the units of the healthcare facility.As such healthcare facilities may provide medication and supplies tohundreds of patients, each requiring a unique medication regimen,automation of medication distribution can be difficult. Further,medication regimens can change based on a patient's changing conditionsor a patient's response to previously administered medications.Automated systems to dispense medications in such an environment mayrequire flexibility to change medication regimens for individualpatients as needed, and also provide medication as it is needed, whereit is needed in the healthcare facility.

Embodiments of systems according to the present invention may provide asystem for predicting the medications which may be needed by a patientover a specific period of time. The prediction may be performed bysoftware which may be configured to use a variety of methods todetermine what medications and supplies may be required over a specificperiod of time. The predicted medication and any known medication (e.g.,medication previously prescribed) may constitute a medication order. Themedication order may be sent (e.g., by a healthcare facility network),to a central pharmacy for fulfillment.

The central pharmacy of a healthcare facility may be configured toreceive a medication order and to fulfill the medication order bypicking the medications of the medication order from a supply ofmedications. The picking may be performed manually by a pharmacist orpharmacy technician, or the picking may be performed automatically by anautomated dispensing system, such as a Robot-Rx™ from McKesson®. Themedication, whether picked manually or automatically, may be packagedinto overpacks, if not already in a suitable package for automation. Forexample, the types of packages handled by the Robot-Rx™ may becompatible with some embodiments of automation such that repackaging isnot necessary. In other embodiments, the medication, if contained in apackage, such as a blister pack, may require packaging in an overpackthat is compatible with specific automation systems. In the instantembodiment, picked medications are loaded into bins, such as the bins102-108 of FIG. 1 , which are configured to be compatible with variousautomation components and systems described herein.

Supplies may also be part of the medication order as determined by thesoftware (e.g., a syringe of a given size may be known by the softwareto accompany a medication vial of a given size). Optionally, suppliesmay be added to a medication order manually, for example when authorizedmedical personnel recognize a need (e.g., a patient's IV tubing ispunctured requiring new IV tubing to be ordered). In example embodimentsin which the central pharmacy and the central supply store arecollocated, or in close proximity to one another, after medications areloaded into overpacks, the requisite supplies may also be loaded intothe overpacks before the overpacks are grouped and transported to theunit storage device. Additionally or alternatively, particularly inembodiments in which the central supply store and the central pharmacyare not in close proximity, supplies may be loaded to separateoverpacks. The overpacks of supplies may be grouped according tolocation and transported accordingly. The unit storage device may beconfigured to associate a supply with a medication for distribution toan authorized medical person.

The medications for a medication order for a patient may each be loadedinto separate bins, such that the bins each contain a unit dose ofmedication. Supplies may also be loaded into individual bins. In somecases, supplies which correspond to a particular medication may beloaded into the same overpack bin as the medication to which they areassociated. The overpacks may be loaded manually by a pharmacytechnician or pharmacist, or the overpacks may be loaded automatically,as illustrated in FIG. 6 . Appropriately sized bins may be selectedbased upon the size of the medications or supplies to be receivedtherein. In some embodiments, software may designate the size of bin tobe used for a particular medicine or supply, which may be preferred inembodiments implementing an automated overpack fill.

A label may be applied to each overpack to identify the contentsreceived therein and/or to identify the patient for whom the overpack isintended. The overpack label may include identifying indicia such as abarcode, text, picture, etc. Optionally, an RFID tag on the overpack maybe written to by an RFID encoder. The RFID tag may be written with thepatient information, patient location, medication information, etc.Labels for overpacks which are intended for multiple uses may betemporarily affixed such as with a releasable adhesive, a hook-and-loopfastener system, or received within a label receiving area of theoverpack, such as a transparent pouch.

Including only a single dose of medication in each overpack may alloweach labeled overpack to be individually manipulated throughout thedispensing process. For example, when the overpack is at the centralpharmacy, transported to the unit storage, at the unit storage, inproximate storage, or at the nurse server or patient server, the unitdose overpack may be identified by the label and manipulated as needed.In an embodiment in which a particular medication was removed from aperson's medication regimen, the unit dose of that medication may beremoved and routed for return to the central pharmacy at various pointsduring the dispensing process.

In some embodiments wherein each overpack contains a unit dosemedication, each overpack may be individually routed to the patient forwhom it is intended. For example, upon determining that a medication isanticipated to be needed by a patient, logistics software may plan aroute for the individual unit dose between the central pharmacy and theproximate storage. The route may be the same as other medicationsdestined for the same patient; however, as each medication unit dose isindividually traceable and manipulated, each overpack may have anindividual route that is assigned to it. Grouping of overpacks withsimilar destinations may be another function of the logistics software;however, each overpack maintains its unique identity and route. As such,if a group of medications is separated during loading/unloading ortransport, each of the overpacks will still arrive at the appropriatedestination. Further, if an individual medication is flagged for removalfrom the patient's medication order, the route of that medication may bechanged to re-route the medication back to the central pharmacy.

Individual routing of medications may allow individual control of themedications, such as when a medication must be removed from a patient'sregimen due to a lot recall, expiration of medication, a changeassociated with the patient status (e.g., improving/worsening condition,discharge of patient, movement of patient to another location, etc.), amore urgent need for a medication for another patient, etc.

Embodiments may use unit-dose overpacks; however, additionally oralternatively, all of the medications and supplies for a patient thatmay be needed over a specific time period may be grouped together into asingle overpack. Such an embodiment may reduce the overall number ofoverpacks needed for a facility and may increase the efficiency ofdispensing the medications and supplies; however the ability toindividually manipulate unit doses automatically may be lost. Somemedications may be grouped together by their purpose, for instance amedication that includes nausea as a side effect may be grouped with ananti-nausea medication. As such, removing the medication with a sideeffect removes the need for the nausea medication, such that themedications may be grouped together in a single overpack without theneed to track them individually.

While the above embodiment has been described with respect to a centralpharmacy of a healthcare facility, the central pharmacy role may beremoved from the healthcare facility and may be implemented in a remotelocation. A remote central pharmacy may be a pharmacy which servesmultiple healthcare facilities and may benefit from economies of scale,particularly when servicing smaller healthcare facilities. As such,embodiments of the above may be implemented at a remote central pharmacywhere the overpacks are prepared off-site, and subsequently delivered toa healthcare facility for distribution to healthcare facility unitsand/or patients.

The overpack bins of the above described embodiment may be staged in alocation at the central pharmacy (or at a receiving location within ahealthcare facility) and may be grouped according to their destination.For example, overpacks that are designated to go to a patient on thelong-term care unit may be grouped together, while overpacks designatedto go to an intensive care unit (ICU) may be grouped together. Thegrouping of overpacks together may be performed automatically, forexample by the logistics software that routes medications to theappropriate patients. Optionally, the grouping of overpacks may beperformed manually.

The grouping of overpacks may include placing the bins on a tray, asillustrated in FIG. 11 . The bins may be lidded bins, or a lid may beplaced over the group of bins on the tray as illustrated. The groupedoverpacks may then be loaded onto a transport cart, as shown in FIG. 18, for transport to the appropriate local storage or unit storage device.

The transport cart may be moved automatically, for example, using anautomated guided vehicle, or the cart may itself be an automated guidedvehicle. In other embodiments, the cart may be moved manually to theunit storage device in the appropriate unit of the healthcare facility.

Upon arrival at the unit storage device, as shown in FIG. 20 , a traycontaining the overpacks may be removed from the cart, and loaded intothe unit storage device. The lid from the tray may be removed, and thetray may be loaded into the unit storage device. Optionally, theoverpacks may be loaded into the unit storage device without the tray,and the tray and lid may be returned to the cart for return to thecentral pharmacy.

The transport cart may include only medications and supplies for aspecific unit of a healthcare facility, or optionally, the transportcart may include trays of overpacks for different units of a healthcarefacility. In such a case, the trays designated for a first unit storagedevice may be loaded into the first unit storage device, while traysdesignated for a second unit storage device may be loaded into a secondunit storage device as the transport cart makes rounds delivering theappropriate trays to the appropriate unit storage device.

The unit storage device may be configured with a retrieval device asillustrated in FIG. 23 , which may include an X-Y robot arranged totraverse the unit storage device. The overpacks may each be accessibleto the retrieval device as the X-Y robot moves the retrieval deviceacross the unit storage device. As outlined above, the medications for amedication order may be needed for a specific time period. Themedications may be stored within the unit storage device until such timeas the medications are anticipated to be needed, or when they areactually needed. In an example embodiment, the medications of amedication order are retrieved in advance of the time at which they areanticipated to be needed. The overpacks may be staged proximate atransport device, such as the train of FIG. 23 . Before the time thatthe medications are anticipated to be needed, a loading device may loadthe overpacks containing the medication order onto a transport device.

A transport device according to example embodiments of the presentinvention may include a train car with one or more bogies adapted toride along a rail. FIG. 53 illustrates a side view of an exampleembodiment of a train car 800 configured to advance along track 810. Thetrain car 800 includes a load surface 812 arranged to carry medicationand supply overpacks. The load surface 812 may be configured to carryany specific kind of overpack securely. For example, in the case of thebin-type overpacks, the train car may be equipped with a top that isarranged proximate the top of the bins loaded into the train car. Thetop may be configured to prevent shifting and moving of the overpacks asthe train car travels along the rails. The illustrated train car 812further includes bogies 814 which are configured to ride along the rail810. The bogies may each include at least one top roller 816 adapted toride along the top of the rail 810, and a pair of side rollers 818arranged on either side of the rail 810 and adapted to keep the bogie814 centered on the track 810. The bogies 814 may each be pivotablyconnected to the load surface 812 by pivot points 820. The pivot points820 may allow the bogies 814 to turn relative to the load surface 812such that the train car can advance around bends. The length of thetrain car 800 (or the length between the bogies) and the pivotability ofthe bogies 814 may determine the minimum radius track turn that can beused in a system using the train cars 800.

The train car 800 may be advanced along the track by a drive wheel,which may be one or more of the top rollers 816 and/or side rollers 818.Embodiments may include a local energy source disposed on the train car,such as a battery, which may drive an electric motor to turn the drivewheels. Optionally, the track may include bus bars to conductelectricity along the track from which the train car 800 may tap into.As such, the track may provide power to the motor which drives the drivewheels. Other mechanisms for advancing the train car along the track mayinclude a cable disposed within or proximate to the track which may pullthe train car along the track. A cable disposed within the track may beconfigured in a continuous loop through the track disposed in anoverhead location of a healthcare facility unit. The cable may movesubstantially constantly, and the train may be adapted to engage thecable to advance the train, and disengage the cable to stop the train.Other embodiments may include a magnetic levitation system adapted toadvance the train car along the track.

The transport device may receive the overpacks as outlined above, andthen transport the overpacks to proximate storage. The overpacks may bestaged at the proximate storage, or at a nurse or patient server asoutlined above. In some embodiments, the transport device is stagedalong with the overpacks.

As illustrated and described above with reference to FIG. 29 , a traincar according to example embodiments may include a scanner 404configured to read the identifying indicia of the overpacks. The scannermay be disposed on the train car configured to scan overpacks to beloaded; however, scanners may also be implemented at the proximatestorage staging area, the unit storage device, and the nurse server.Scanners may be implemented to provide additional tracking andconfirmation of the arrival of medications at particular locations. Forexample, a proximate storage location may include a scanner which scansthe overpacks on a transport device that has arrived at the proximatestorage location, and direct unloading of the overpacks that are to bestaged at the proximate location.

Embodiments of a transport device according to the present invention mayinclude a system for tracking the location of the transport device. Sucha system may include radio frequency beacons disposed along the trackand an RFID tag on the train car. Such a system could identify thelocation of the train car anywhere along the track with high accuracy.Other embodiments may include sensors disposed along the trackconfigured to detect the presence of a train car and to scan an identityof the train car to determine and track the train car's location. Inother embodiments, location codes may be disposed about the track. Thelocation codes may be in the form of RFID tags, barcodes, or otherindicia which may be read by a scanner of a train car. The train car mayscan the indicia along the track and provide that information to asystem tracking the location of the train car. As such, the specificlocation of a train car and the contents thereon may be known throughoutthe transport process.

When an authorized medical person is prepared to administer medicationto a patient, they may access a nurse server or patient server accordingto any of the embodiments described above. The authorized medical personmay access the user interface of nurse server or patient server byidentifying themselves and the nurse server confirming that they are anauthorized medical person. In an example embodiment in which no userinterface may be present, such as the nurse server of the embodiment ofFIG. 51 , the staged medication may be dispensed to the authorizedmedical personnel. In an example embodiment in which a user interface ispresent on the nurse server, the authorized person may select thepatient or simply accept the medication that is staged awaitingdispensing. Thereafter, the medication may be dispensed to theauthorized medical person.

To dispense the medication from the overpacks of the aforementionedexample embodiment, the bins may be tilted or “dumped” to have thecontents dispensed from the nurse server. The nurse server may includestructure sufficient to slow the descent of the medications and suppliesto accommodate a relatively soft landing at the dispensing area of thenurse server. Alternatively, the overpack bins may be lowered throughthe nurse server and presented to the authorized medical person forretrieval of the medications and supplies. The empty overpacks may bereturned to the nurse server, which may return the overpacks to thetransport device, or to the staging area configured to be retrieved bythe transport device. The transport device may return empty overpacks oroverpacks containing unused or unneeded medications back to the unitstorage device. The empty overpacks and unneeded medications may beretrieved and returned to the central pharmacy for reuse.

A Second Example Embodiment of a System

Another example embodiment of a system incorporating various componentsoutlined above is described herein. According to an example embodiment,a system may be configured to deliver medications that are anticipatedto be needed by a patient ahead of the anticipated need. In oneembodiment, a system may be configured to predict the needs of patientsin a healthcare facility. The system may predict the anticipatedmedication needed by the patient using a variety of manners, such as oneor more of a conventional medication regimen for a particular ailment, aphysician specific medication regimen for a particular ailment, ahistorical record of unit dose medications, or an algorithm. Thealgorithm may predict the anticipated medications needed by a patient byfactoring in patient conditions, symptoms, patient information (e.g.,gender, age), etc. The algorithm may determine a medication or pluralityof medications which may be used to treat a patient with the combinationof symptoms and conditions.

Upon predicting the medications anticipated to be needed by a patient,the medication order, including each of the anticipated medications, maybe sent to a central pharmacy. The central pharmacy may manually orautomatically fulfill the medication order. For example, a Robot-Rx™automated dispensing system may receive the medication order anddispense each of the medications anticipated to be needed by thepatient. The medications may be loaded into overpacks; however, in thecase of an automated dispensing system, the medications may already becontained in packages which are suitable for automated dispensing. Assuch, the medications dispensed by an automated dispensing system may beready to be loaded into a carrier according to example embodiments ofthe present invention. Medications which may not already be packaged inpackaging suitable for automated manipulation may be packaged into suchoverpacks. In the example embodiment, the overpack may include a bag,such as the bag illustrated in FIG. 4 . The bag may include a hole 142to provide a grasping and holding location for automated devices.

The medication, which is now packaged into overpack packaging suitablefor automated handling, may be loaded into an apparatus which may becompatible with further automated handling and transporting of themedications. FIG. 54 illustrates an example embodiment of a clip 840including a clip body 842 and a hook 844. The clip 840 may be configuredto securely hold an overpack 846, such as the bag overpack describedabove and illustrated in FIG. 4 . The overpack 846 may contain a unitdose medication 848, or alternatively, a plurality of unit dosemedications each anticipated to be needed by a single patient. In suchan embodiment, the overpack is patient-specific rather thanmedication-specific. The clips of example embodiment may be configuredto be manually loaded by, for example a pharmacy technician, oralternatively, the clips may be automatically loaded by a deviceconfigured to insert the overpacks 846 into the clips 840.

The clip 840 of the illustrated embodiment may include identifyingindicia 850 disposed on an area of the clip which will remain visibleduring transport such that the identifying indicia can be scanned.Optionally, the identifying indicia may be stored in an RFID tag whichmay be readable without being visible. The clip 840 of FIG. 54 furtherincludes a release recess 852 as will be described further below. FIG.55 illustrates an example embodiment of a carrier 860 configured tocarry a plurality of clips 854 with overpacks 856. The clips may bereceived into recesses of the carrier which securely hold the clips 854in place during transport of the carrier. The clips may be manually orautomatically loaded into the carrier.

Each carrier may be designated as bound for a specific location within ahealthcare facility. For example, a carrier may be routed to theintensive care unit. Carriers may be configured to hold medications fora plurality of patients proximate their destination, or alternatively,particularly when a patient has a large number of medications, a carriermay be configured to hold only medications for a single patient. Thecarriers may be loaded onto a transport cart, as illustrated in FIG. 19for transport to a unit of the healthcare facility. As illustrated inFIG. 19 , upon arrival at the appropriate unit, the carriers for thatunit may be unloaded from the transport cart and loaded into a unitstorage device. The unit storage device may be any of the unit storagedevices outlined above that are compatible with carriers as describedherein. For example, carriers may be loaded into a unit storage deviceas illustrated in FIG. 25 .

As described above with respect to FIG. 28 , the carriers may beconfigured to be loaded onto a shuttle for transport to a locationproximate a patient. The carriers may be temporarily stored at the unitstorage device. A carrier may be stored until such time as a request isreceived for a medication unit dose contained in an overpack attached tothe carrier. Optionally, the logistics software may anticipate the timethat a medication is needed at a location proximate the patient andadvance the carrier toward a transport device for transport to thelocation proximate the patient in advance of the anticipated need.

According to some embodiments, the unit storage device may only beconfigured to load the carriers onto a transport device, and not providestaging at the unit storage device. In such an embodiment, carriers maybe moved to a location proximate the patient when a transport device isavailable rather than awaiting a request for a medication or aprediction of a need for the medication. Once the carrier is loaded ontoa transport device, for example, as shown in FIG. 28 , the transportdevice may advance the carrier to a location proximate the patient orpatients for whom the medication of the overpacks of the carrier arefor. The carrier may be staged at the location proximate the patient,which may be in proximate storage, at a nurse server, or at a patientserver.

FIG. 56 illustrates an example embodiment of several carriers 870 stagedin proximate storage near a nurse server which receives medicationsalong track 878. The proximate storage may be a location track side awayfrom track 880 to allow other carriers 874 to move along the track 880.The track-side storage may be on a track spur or track loop as outlinedabove, or the carriers may be moved off of shuttles into a storage orholding area by a loading/unloading device at the proximate storagelocation. The track 880 and the proximate storage location for thecarriers 870 may be enclosed in an overhead location, such as byenclosure 872 to keep the medications secure, to keep noise to aminimum, and to avoid potential interference with the carriers andshuttles.

Authorized medical personnel may be alerted that medication is staged atthe proximate storage and ready for dispensing. The alert may be in theform of a light at the proximate storage or nurse station indicatingthat staged medication is present and ready to be dispensed. Optionally,an alert may be sent via wireless network to a portable device, such asto a pager, a nurse cart, a tablet computer, handheld computer, etc. Theauthorized medical person responsible for administering the medicationto the patient may respond to the alert in due course.

Upon arrival at the nurse server or patient server, the authorizedmedical person may identify themselves to confirm to the patient serveror nurse server that they are, indeed authorized. The identification maybe performed as outlined above with regard to the various embodiments ofa nurse station. In response to confirming the identity of theauthorized medical person, the nurse server or patient server mayprovide an indication of the medications available for dispensing, or anindication of the patients for whom medications are available for. Theauthorized medical person may select the medications and/or patients toinitiate the dispensing of the medications.

FIG. 56 illustrates a scanner 876 located near the proximate storage,and FIG. 57 illustrates a detail view of the scanner 876. The scanner876 may include a reader 892 which is configured to read the identifyingindicia of the clip 890. The identifying indicia may be a barcode, text,image, or RFID tag such that the reader 892 may include a barcodescanner, image capture device, or RFID reader. The identifying indiciamay either specify the medication 884 in the overpack 882, oralternatively, the identifying indicia may reference a database wherethe identification of the clip 890 is correlated to a medicationattached thereto, where the database is populated when the medication isloaded onto the clip 890. The clip 890 may be scanned upon arrival atthe proximate storage, or just before dispensing the medication inresponse to an authorized request for the medication. The reader 892 mayconfirm the identity of the clip and medication thereon to confirm thatthe requested medication matches the medication 884 of the overpack 882attached to the clip 890. Provided the medication is the anticipatedmedication, a release mechanism 894 may extend into release recess 886.In response to the release mechanism 894 extending into the releaserecess 886, the overpack 882 may be released from the clip 890 and hook888, allowing the overpack and medication contained therein to fall fromthe clip. The medication may be configured to fall into a tray 896 asillustrated in FIG. 56 , and the tray may be configured to move downtrack 878 for presentation of the medications to the authorized medicalperson. After a carrier is emptied of medication, or if the medicationon the carrier is no longer needed (e.g., when a patient is discharged),the carrier may be advanced by a shuttle back to the unit storage devicefor retrieval and return to the central pharmacy.

A Third Example Embodiment of a System

As described above, various components may be implemented together tocreate a system which automates, or enables at least partial automationof the dispensing of medications and supplies to a patient. Anotherexample embodiment of such a system is described herein.

Embodiments described herein may provide for unit-dose overpacks to beprepared for distribution to patients. Such overpacks have also beendescribed to be configured to receive supplies which may accompanycertain medications, such as a syringe to accompany a medication vial ina single overpack. While overpacks may be unit-dose specific and/orunit-dose and supply specific, overpacks may also be patient-specific.For example, a single overpack may include unit dose medications for aparticular patient for a particular period of time (e.g., for a nurseshift, or for a 24-hour period, etc.). Such an overpack may be a binwhich is configured to hold multiple unit-dose medications and may alsobe configured to hold supplies to accompany the unit-dose medications.The bin may be selected based upon the number and size of medicationsand/or supplies that it is to be filled with for the particular patient.In some embodiments, the unit-dose medications and/or supplies may be inindividual unit-dose overpacks that are loaded into a patient-specificoverpack. For example, a unit-dose overpack may include a bag asillustrated in FIG. 4 and a plurality of unit-dose overpacks may bereceived in a bin, as illustrated at FIG. 1 .

Unit-dose medications and supplies may be loaded to a patient-specificoverpack by a variety of means including manually, automatically, or acombination of manual and automatic loading. For example, a robot, asshown in FIG. 6 , may be configured to load unit-dose medications to apatient-specific overpack. In another example embodiment, as shown inFIG. 14 , a user may retrieve the unit-dose medications for a patient,they may scan the unit doses with reader 32, and may load the unit-dosemedications in a patient specific bin, such as bin 36. In still anotherembodiment, a patient-specific overpack may be filled by unit-doses frommagazines as illustrated in FIG. 15 . In some example embodiments, apatient-specific overpack, such as a bin or an envelope, may be filledby an automated dispensing system such as the Robot-Rx™. Thepatient-specific overpacks may be configured with security mechanisms,such as the latch 128 of the overpack of FIG. 2 . Lockable overpacks maybe useful in environments in which control over the overpacks may not bemaintained between a central pharmacy (or remote central pharmacy) andthe patient. In such an environment, a mechanism to preclude access topatient-specific overpack contents may be desirable.

Upon filling a patient-specific overpack, the overpack may betransported to a unit storage device, or a staging location closer tothe patient for whom the medications are intended. Transport to the unitstorage device may be performed by a track-based transport system,pneumatic tube system, or other such automated system. In otherembodiments, the patient-specific overpacks may be loaded onto a cart. Acart, such as the cart 202 of FIG. 18 , may be configured to receivepatient-specific overpacks either individually, or on trays, such astray 200. While the overpack may include a mechanism to preclude accessto the contents as described above, the cart or other transportmechanism used to transport the patient-specific overpacks to the unitstorage device may include a mechanism for precluding access to thecontents of the overpacks. For example, the transport cart may includedoors or latches to prevent removal of overpacks from the cart. Accessmay be granted to authorized medical personnel upon authentication oftheir identities, such as through biometric identification.

Once the patient-specific overpacks have been transported to a unitstorage device, the overpacks may be unloaded. The unloading may includean automated removal of overpacks from a cart, or a manual removal. Inan example embodiment in which a track-based transport system orpneumatic tube system is used to transport the patient-specificoverpacks, a loading device may be configured to unload the overpacksfrom the transport device and load the overpacks to a staging area,which may be a unit storage device. The unit storage device of exampleembodiments may include any of those illustrated in FIGS. 20-25 .Optionally, staging may occur in an overhead storage location along atransport route along which the patient specific overpacks aretransported to a patient-server or nurse-server for dispensing.

The patient-specific overpacks described above may be filled in responseto a medication order received at a central pharmacy, or in response toa system configured to predict the medications anticipated to be neededby a patient over a particular period of time. The overpacks may also befilled by a combination of a medication order and predicted medications,where the medication order includes medications known to be needed bythe patient and the predicted medication is medication that the systemanticipates may be needed by the patient. The request that apatient-specific overpack be filled may be automated to be generatedonce or more each day, or the request may come from an authorizedmedical person. For example, a nurse may request a patient-specificoverpack for a patient under their care. Orders generated by a nurse maybe sent from a mobile communications device (e.g., a tablet computer, ahand-held computing device, etc.), from a nurse cart (e.g., acomputer-on-wheels (COW) or workstation-on-wheels (WOW)), or from anurse-server, patient-server, or other device in communication with ahealthcare facility network.

Once the patient-specific overpacks are received at a proximate storagelocation or staging area, such as a unit storage device or overheadstorage location, for example, the patient-specific overpacks may beready for transport to an appropriate patient or nurse server.Authorized medical personnel may be alerted to the arrival of apatient-specific overpack at the unit storage device or staging area byan alert sent to a mobile device, a nurse cart, a nurse server, apatient server, etc. Such an alert may advise the authorized medicalperson that the patient-specific overpack is ready for transport to alocation for retrieval by the authorized medical person.

When medications and/or supplies are needed for a patient, thepatient-specific overpack may be requested by an authorized medicalperson. The request may be generated by the authorized medical personusing a mobile communications device, a nurse cart, a patient server, anurse server, or a workstation, for example. The request may bepatient-specific, such that an authorized medical person may request themedications for a specific patient. Optionally, a request may include arequest for patient-specific overpacks for a plurality of patients, suchas all of the patients under a particular authorized medical person'scare, or all of the patients in a particular location within thehealthcare facility. The request may also specify the desireddestination for the patient-specific overpacks. For example, a nurse mayrequest the medications for two patients located in different rooms. Therequest may indicate that the patient-specific overpacks for bothpatients should be sent to a location closest to where the nurse is, oris planning to be. Once the request is sent for the patient-specific binor bins, an estimated time-of-arrival (ETA) of the patient-specificoverpacks at the specified location may be generated. The ETA may beprovided to the requesting authorized medical person on a mobile device,on their nurse cart, on a patient server or nurse server, or otherwisecommunicated to the authorized medical person.

The patient-specific overpack(s) may then be transported from the unitstorage device or staging area by any one of number of transportdevices. For example, a patient-specific overpack may be retrieved by aretrieval device of an X-Y robot, as illustrated in FIG. 23 , andloaded, by a loading device, onto a transport device. The transportdevice may include a car, such as car 320, for transport along the trackto the location specified by the authorized medical person. While atrack-based transport device is described, other transport devices, suchas pneumatic tubes, conveyors, or the like may be used to advance thepatient-specific overpacks from the unit storage device or staging area.

Upon arrival of the patient-specific overpacks at the location specifiedby the requesting authorized medical person, an alert may be generated.The alert may be sent to a mobile device, nurse cart, patient or nurseserver, etc. The alert may be an audible alert, a visible alert, or acombination thereof. For example, an audible alert may be provided viathe mobile device, and a visible alert, such as a light, may beilluminated at the location where the patient-specific overpacks are tobe retrieved. In order to access the patient-specific overpacksrequested, the authorized medical person may be required to authenticatetheir identity at the location where the patient-specific overpacks areto be retrieved. For example, a nurse server including a user interfacemay allow an authorized medical person to identify themselves through abiometric scan, passcode entry, or key/identification card scan. Oncethe authorized medical person is identified and authenticated, thepatient-specific overpacks may be presented to the authorized medicalperson.

A variety of mechanisms may be employed to present the patient-specificoverpacks to the authorized medical person. For example, thepatient-specific overpacks may be awaiting retrieval in an overheadlocation proximate a nurse server, as shown in FIG. 51 . Uponauthentication of the authorized medical person, the patient-specificoverpacks 590 may be lowered to a retrieval position from which theauthorized medical person may retrieve them. Other embodiments ofmechanism for presenting the patient-specific overpacks may be used toensure that the patient-specific overpacks and/or the contents therein,are inaccessible except to an authorized medical person afterauthentication. The patient-specific overpacks may be held in aninaccessible location or remain in a locked position until such time asthe appropriate authorized medical person is authenticated and thepatient-specific overpacks are released for retrieval.

An authorized medical person may retrieve one or more patient-specificoverpacks in dependence upon the system employed. For example, a nursemay retrieve a plurality of overpacks for a plurality of patients, andload them into a nurse-cart. The nurse may then distribute medicationsfrom the patient-specific overpacks as each patient is visited andattended to. Optionally, the patient-specific overpack may be dispensedto an authorized medical person for immediate use, such as using apatient-server in or near a patient room. Upon dispensing of apatient-specific overpack at a patient server, the authorized medicalperson may administer the medication, and return the overpack.

In example embodiments in which an overpack is re-used and not disposedof, the overpack may be returned via a nurse-server or patient-server,and transported by transport device back to a unit storage device.Optionally, used overpacks may be returned directly to a unit storagedevice. The used overpacks may be retrieved from the unit storagedevice, for example, when new patient-specific overpacks are distributedto the unit storage device. Whether the new overpacks are transported bytrack-based transport, pneumatic tube systems, or transport carts, whilethe transport device is at the unit storage device, empty overpacks maybe loaded to the transport device for return to the central pharmacy.

FIG. 58 is a flowchart of a method and program product according to anexample embodiment of the present invention. It will be understood thateach block of the flowchart and combinations of blocks in the flowchartmay be implemented by various means, such as hardware, firmware,processor, circuitry, and/or other devices associated with execution ofsoftware including one or more computer program instructions. Thesecomputer program instructions may also be stored in a non-transitorycomputer-readable memory that may direct a computer or otherprogrammable apparatus to function in a particular manner, such that theinstructions stored in the computer-readable memory produce an articleof manufacture which implements the functions specified in the flowchartblocks. The computer program instructions may also be loaded onto acomputer or other programmable apparatus to cause a series of operationsto be performed on the computer or other programmable apparatus toproduce a computer-implemented process such that the instructions whichexecute on the computer or other programmable apparatus implement thefunctions specified in the flowchart block(s).

Accordingly, blocks of the flowchart support combinations of means forperforming the specified functions and combinations of operations forperforming the specified functions. It will also be understood that oneor more blocks of the flowchart, and combinations of blocks in theflowchart, can be implemented by special purpose hardware-based computersystems which perform the specified functions, or combinations ofspecial purpose hardware and computer instructions.

In this regard, a method according to one embodiment of the invention,as shown in FIG. 58 , may include receiving an indication of one or moreunit dose medications anticipated to be needed by a patient at 1010. Themethod may also include retrieving the one or more unit dose medicationsfrom a unit storage device (shown at 1020) and loading the one or moreunit dose medications onto a transport device (shown at 1030). Theillustrated method further includes transporting the one or more unitdose medications from the unit storage device to a location proximatethe patient at 1040 and transferring one or more of the unit dosemedications from the transport device to a staging area at the locationproximate the patient at 1050.

In some embodiments, certain ones of the operations may be modified orfurther amplified as described below. Moreover, in some embodimentsadditional operations may also be included. It should be appreciatedthat each of the modifications, optional additions, or amplificationsbelow may be included with the operations above either alone or incombination with any others among the features described herein. Withreference to the method of FIG. 58 , in some example embodiments, themethod may include dispensing the one or more unit dose medications fromthe staging area to authorized medical personnel in response toreceiving a request from the authorized medical personnel as shown at1060. The dispensing may be performed through a nurse server, patientserver, or other means for presenting the one or more unit dosemedications to the authorized medical person.

In an example embodiment, an apparatus for performing the method of FIG.58 may include a processor configured to perform some or all of theoperations (1010-1060) described above. The processor may, for example,be configured to perform the operations (1010-1060) by performinghardware implemented logical functions executing stored instructions, orexecuting algorithms for performing each of the operations.Alternatively, the apparatus may include means for performing each ofthe operations described above.

An example of an apparatus according to an example embodiment mayinclude at least one processor and at least one memory includingcomputer program code. The at least one memory and the computer programcode may be configured to, with the at least one processor, cause theapparatus to perform the operations 1010-1060 (with or without themodifications and amplifications described above in any combination).

An example of a computer program product according to an exampleembodiment may include at least one computer-readable storage mediumhaving computer-executable program code portions stored therein. Thecomputer-executable program code portions may include program codeinstructions for performing operations 1010-1060 (with or without themodifications and amplifications described above in any combination).

Many modifications and other embodiments of the inventions set forthherein will come to mind to one skilled in the art to which theseinventions pertain having the benefit of the teachings presented in theforegoing descriptions and the associated drawings. Therefore, it is tobe understood that the inventions are not to be limited to the specificembodiments disclosed and that modifications and other embodiments areintended to be included within the scope of the appended claims.Moreover, although the foregoing descriptions and the associateddrawings describe example embodiments in the context of certain examplecombinations of elements and/or functions, it should be appreciated thatdifferent combinations of elements and/or functions may be provided byalternative embodiments without departing from the scope of the appendedclaims. In this regard, for example, different combinations of elementsand/or functions than those explicitly described above are alsocontemplated as may be set forth in some of the appended claims.Although specific terms are employed herein, they are used in a genericand descriptive sense only and not for purposes of limitation.

That which is claimed:
 1. An apparatus comprising processing circuitryand at least one memory including computer program code, the at leastone memory and computer program code configured to, with the processingcircuitry, cause the apparatus to at least: receive an order for apatient, wherein the order includes at least one medication; provide forretrieval of a patient-specific container for the order; provide forretrieval of the at least one medication for the order and placement ofthe at least one medication in the patient-specific container for theorder; provide for transport of the patient-specific container to aretrieval location, wherein the retrieval location comprises a pluralityof doors, each of the plurality of doors providing access to arespective area within the retrieval location; and provide access via adoor of the plurality of doors to the area within the retrieval locationcontaining the patient-specific container in response to identifying auser requesting retrieval of the patient-specific container, wherein thepatient-specific container is retrieved by the user for transport to thepatient.
 2. The apparatus of claim 1, wherein causing the apparatus toprovide for retrieval of the at least one medication for the order andplacement of the at least one medication in the patient-specificcontainer for the order comprises causing the apparatus to: identify atleast one storage location for each of the at least one medication;advance a robotic retrieval device to the at least one storage location;retrieve the at least one medication; and deposit the at least onemedication in the patient-specific container.
 3. The apparatus of claim2, wherein causing the apparatus to retrieve the at least one medicationfurther comprises causing the apparatus to: scan contents of the atleast one storage location; identify contents of the at least onestorage location; and retrieve the at least one medication from the atleast one storage location in response to identified contents of the atleast one storage location corresponding to the at least one medicationof the order.
 4. The apparatus of claim 3, wherein the at least onestorage location comprises at least one storage location within a trayof a plurality of trays in a vertically stacked arrangement, each traycomprising a plurality of medications, wherein each of a plurality ofstorage locations within each tray is uniquely identified by acontroller, and each uniquely identified location within the tray isassociated with a medication received within the respective location. 5.The apparatus of claim 1, wherein the patient-specific container isselected based on a cumulative size of the order.
 6. The apparatus ofclaim 1, wherein the retrieval location comprises a transport cart. 7.The apparatus of claim 1, wherein causing the apparatus to provideaccess via a door of the plurality of doors comprises causing theapparatus to unlock the door of the plurality of doors in response toidentifying the user as a person authorized to retrieve thepatient-specific container.
 8. The apparatus of claim 1, wherein causingthe apparatus to provide for retrieval of a patient-specific containerfor the order comprises causing the apparatus to: identify a size of acontainer based on the order; retrieve a container of the identifiedsize; scan an identifier associated with the container; and associatethe identifier with the patient to render the container thepatient-specific container.
 9. The apparatus of claim 8, wherein theapparatus is further caused to track a location of the patient-specificcontainer using the identifier throughout a healthcare facility.
 10. Amethod comprising: receiving an order for a patient, wherein the orderincludes at least one medication; providing for retrieval of apatient-specific container for the order; providing for retrieval of theat least one medication for the order and placement of the at least onemedication in the patient-specific container for the order; providingfor transport of the patient-specific container to a retrieval location,wherein the retrieval location comprises a plurality of doors, each ofthe plurality of doors providing access to a respective area within theretrieval location; and providing access via a door of the plurality ofdoors to the area within the retrieval location containing thepatient-specific container in response to identifying a user requestingretrieval of the patient-specific container, wherein thepatient-specific container is retrieved by the user for transport to thepatient.
 11. The method of claim 10, wherein providing for retrieval ofthe at least one medication for the order and placement of the at leastone medication in the patient-specific container for the ordercomprises: identifying at least one storage location for each of the atleast one medication; advancing a robotic retrieval device to the atleast one storage location; retrieving the at least one medication; anddepositing the at least one medication in the patient-specificcontainer.
 12. The method of claim 11, wherein retrieving the at leastone medication further comprises: scanning contents of the at least onestorage location; identifying contents of the at least one storagelocation; and retrieving the at least one medication from the at leastone storage location in response to identified contents of the at leastone storage location corresponding to the at least one medication of theorder.
 13. The method of claim 12, wherein the at least one storagelocation comprises at least one storage location within a tray of aplurality of trays in a vertically stacked arrangement, each traycomprising a plurality of medications, wherein each of a plurality ofstorage locations within each tray is uniquely identified by acontroller, and each uniquely identified location within the tray isassociated with a medication received within the respective location.14. The method of claim 10, wherein the patient-specific container isselected based on a cumulative size of the order.
 15. The method ofclaim 10, wherein the retrieval location comprises a transport cart. 16.The method of claim 10, wherein providing access via a door of theplurality of doors comprises unlocking the door of the plurality ofdoors in response to identifying the user as a person authorized toretrieve the patient-specific container.
 17. The method of claim 10,wherein providing for retrieval of a patient-specific container for theorder comprises: identifying a size of a container based on the order;retrieving a container of the identified size; scanning an identifierassociated with the container; and associating the identifier with thepatient to render the container the patient-specific container.
 18. Asystem for dispensing of medication comprising: a user-interfaceconfigured to receive an order for a patient, wherein the order includesat least one medication; a robot configured to: retrieve apatient-specific container for the order; retrieve the at least onemedication for the order and place the at least one medication in thepatient-specific container for the order; and transport thepatient-specific container to a first area; and a retrieval locationcomprising a plurality of doors, each of the plurality of doorsproviding access to a respective area within the retrieval location,wherein the patient-specific container is received at the first areawithin the retrieval location, wherein a user requesting retrieval ofthe patient-specific container is provided access via a door of theplurality of doors to the first area in response to identifying the userrequesting retrieval of the patient-specific container for transport tothe patient.